Please PRINT and MAIL IN this form or EMAIL to kataylor@rogers.com Online payments can also be made to this email
2017 July 15 and 16
Registration Form
NAME:________________________________________________
ADDRESS:_____________________________________________
TOWN/CITY: __________________________________________
PROVINCE/STATE, COUNTRY: __________________________
POST/ZIP CODE:_______________________________________
PHONE:_______________________________________________
Daily Rate ___ SESSIONS X $60 CDN = $______
|
2 Days $95.00 CDN___ |
FEES SENT WITH FORM CDN$______
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