19-20 Ninja Kids Martial Arts® Registration Registration Date*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Parent Name* First Last Child's Name* First Last Child's Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Which group are you registering for?*Kids 3-5Kids 6-8Kids 9-10Teens (11+)Measured Height of your child in Feet and Inches*Is your child a returning Ninja Kids Member?*NoYesYour Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Your Email* Enter Email Confirm Email PhoneEmergency ContactName Emergency Contact* First Last Phone Emergency Contact*Payment OptionsTraining Fee Payment*3-10 Per Month $42.503-10 Whole Year $34011+ Per Month $5011+ Whole Year $400Pay per month. When paying for the full year upfront, your child trains one month for FREE.Method of Payment*Interac DebitCredit CardAutomatic Credit Card PaymentCash or ChequeI wish to purchase the Ninja Kids Starter Pack*Yes for Ninja Kids 6+ and upYes, for Ninja Kids 3 -5NoThe Starter pack for Ninja Kids 6+ and up consists of Uniform, Patch, and Ninja Kids Training Guide. The Starter Pack for Ninja Kids 3 -5 consists of an official Ninja Kids Martial Arts Training shirt and also covers small materials used throughout training.Total $ 0.00 CAD Medical Release and Informed Consent Liability WaiverI understand that in the event the student listed above is significantly injured, ill, unconscious, and/or no one otherwise authorized to contact Emergency Medical Service (EMS) personnel is present; it will be the practice of the instructor(s) to contact EMS personnel on behalf of the student. I give my permission for responding EMS and hospital personnel to begin necessary treatment. Furthermore, I agree to be financially responsible for any and all medical treatment for student listed herein. By signing this form, I agree that I have been informed that my child should not participate in any activity if I have any doubt or if I am uncertain as to my child’s current medical condition. I understand that I should always seek medical advice before starting any physical training program. I understand that the activities in which my child participates are physically and mentally intense and may require extreme exertion and give rise to the possibility of injury or death. I hereby certify that my child is in good health and does not suffer from any heart condition or other ailment that could be exacerbated by the exertion involved in the activities in which s/he participates. I confirm and agree that I am fully aware of the risk and certify that my child is physically able to participate in this program’s activities. I further agree that I will comply with all the rules, regulations, and instructions given to me by any program instructor, assistant instructor, or training group official. Further, I (on behalf of my heirs, personal representatives, executor, and administrator) hereby waive, release, remise, covenant not to sue and forever discharge from any claims and liabilities whatsoever without limitations that I have which arise against Chris de Feijter, Taka Budo Dokokai Martial Arts Inc., or any operator, official, supervisor, officer, participant, agent, instructor, agent, judge, volunteer, sanctioning entity, or employee or student from any expense, damage, loss, injury, or liability (including lawyer fees) due to my decision to participate in any activity, class, seminar, or other event sponsored by Taka Budo Dokokai Martial Arts Inc. I agree to indemnify and hold harmless the above mentioned entities for any and all loss, injury, damage, claim, and liability. I confirm that I either have specific insurance to cover any injuries that my child may sustain or that I have chosen to have my child participate in these activities without any insurance coverage and agree to assume full responsibility of risk and bodily injury, death, and property damage. I hereby assume any and all risks, known and unknown, which may arise from my decision to have my child participate in this activity. I agree to allow Taka Budo Dokokai Martial Arts Inc. and affiliates to utilize any photograph, audiovisual recording, or other digital media taken of me and/or my child at any class or event. I understand that I will not be compensated in any way for use of any such digital media. I have read this medical release and Informed consent liability waiver in its entirety. As an authorized party, I agree with the Medical Release and Informed Consent Liability Waiver:*No, I do not agreeYes, I agreeName of Responsible and Legally Authorizing Party:*Entering your name in the above field acts as electronic signature. This iframe contains the logic required to handle Ajax powered Gravity Forms.