Karate Summer Intensive 2022

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**PLEASE NOTE: This is full days of training intermediate to advanced techniques, NOT a summer camp.

Date: August 2 - 5, 2022
Time: 9:00am - 4:00pm
Location: Karate - Do Academy

This is for students who are GREEN BELT+ and age 10+. Younger lower belts are still able to apply and it will be determined by an Instructor if they are able to attend on a case by case basis. Students must be able to commit to fairly long days of challenging training.

All participants will need to bring a bagged lunch, water bottle, sparring equipment, uniform and another training top/tshirt.

Email *

Student Name *

Date of Birth *

YYYY

Age **If younger then 10 years old, participation will be determined by Instructor on a case by case basis. *

Belt Rank **If belt rank is lower then GREEN, participation will be determined by an Instructor on a case by case basis. *

Address *

Parent/Guardian Name(s) - if over 18 write Emergency Contact Info *

Phone #1 *

Phone #2 *

Intensive Fees

Fee for the intensive is $200 (GST INCLUDED)

An email will be sent by June 16th, to confirm their spot in the Summer Intensive and will include payment information.
PLEASE DO NOT SPEND PAYMENT PRIOR TO CONFIRMATION EMAIL.

Wavier Release Form

By completing this online registration form you are agreeing to the liability waiver as follows.

The registrant being the custodial parent or legal guardian of a person under 18 years of age, on behalf of a minor or on behalf of themselves if over 18 years of age, hereby acknowledge the risk of injury inherent in the sports and activities conducted by the Karate-Do Academy being a division of 1577484 Alberta Ltd. (herein after called “The Club”) and that the same, including sparring, and strenuous exercise, may result in serious injury on
occasion.

The registrant hereby voluntarily consents to allow participation by the minor/themselves in the
activities at HIS/HER OWN RISK, and acknowledges that he/she has been advised that he/she may withdraw at
any time without refund of fees. The registrant further acknowledges he/she has advised The Club that the participant or the
minor, as the case by be, SUFFERS FROM NO SERIOUS PHYSICAL DISABILITIES AND IS IN GOOD HEALTH.
In consideration of the club granting the participant a membership in The Club, the registrant for the
participant, hereby waives, releases, and discharges, The Club, his/her insurers, successors, employees,
independent contract instructors, owners and legal representatives, for any and all liability for injury occurring,
or arising out of and related to any and all of the activities, FUTURE AND PRESENT, however such injury occurs
(whether by any act or omission, default, or breach of duty) and not withstanding that such injury my have been
caused by, or been contributed to, negligence or gross negligence of the The Club, its ages, employees,
independent contract instructors or owners.

I agree that the participant is and in the future will be continuing to participate in the activities of The Club at his/her own risk. I further agree the participant will fully adhere to all the written or oral rules and instruction of The Club or its owners as set out going forward.

** Photos take of students at The Club may be posted on our website, physical or electronic print
ads/promotions, and/or social media accounts **

** I may receive communication from The Club via phone or email regarding upcoming events/announcements
as necessary to ensure students and parents/guardians are informed **

THE ABOVE RELEASES AND WAIVER IS HEREBY GIVEN BY MY COMPLETION OF THIS REGISTRATION FORM

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