Please PRINT and MAIL IN this form or EMAIL to kataylor@rogers.com Online payments can also be made to this email

2016 September, 3-5

Tombo Fall Seminar

Registration Form

NAME:________________________________________________
ADDRESS:_____________________________________________
TOWN/CITY: __________________________________________
PROVINCE/STATE, COUNTRY: __________________________
POST/ZIP CODE:_______________________________________
PHONE:_______________________________________________
 
 
Daily Rate ___ SESSIONS X $60CDN = $______
3 Days $150.00CDN___

FEES SENT WITH FORM CDN$______  
Fees don't include travel/room/food.

PLEASE READ THE FOLLOWING CAREFULLY

I, the undersigned applicant to the Tombo Dojo Fall Kage Ryu Seminar understand that I am applying for instruction in kenjutsu, an activity that involve physical activity. I further understand that the Sei Do Kai and associated persons carries no insurance against injury to any of the participants in the seminar.

I hereby acknowledge that I am assuming the risk and responsibility for any and all injuries that I may suffer due to injury, suffered by me, or caused by third parties to me arising out of the practice of Niten Ichiryu, Kage Ryu, or during the use of any of the facilities available. I further acknowledge that I am responsible for providing my own personal health, medical, dental and accident insurance coverage. I hereby release the Sei Do Kai and all of its associated persons from liability for any injury or loss suffered by myself.

DATE_______ SIGNATURE ______________________________

PARENT/GUARDIAN (under 18)___________________________



Please mail this form, cheques payable to: Sei Do Kai
E/Mail to: Kim Taylor kataylor@rogers.com at 44 Inkerman Street, Guelph Ontario Canada N1H 3C5