Training Registration Your Name First Last Date of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Your Phone*Your Email* Enter Email Confirm Email Emergency ContactEmergency Contact* First Last Emergency Contact Phone*Experience and Selection of Martial ArtDo you have experience with Martial Arts?*NoYesDescribe your experience*Which Martial Art(s) in our school would you like to register for?* Suigetsujuku Nihon Jujutsu Meifu Shinkage Ryu (small handheld weapons) Yagyu Shinkage Ryu Kenjutsu (sword fencing) Selecting multiple martial arts does not involve additional training fees. For MSR, a membership fee for the dojo in Japan is required (payable per 6 months, $76).Why do you want to learn a Martial Art?*Fine PrintBelow is a lot of fine print to keep everyone safe, so please read through it carefully.Training ConditionsTraining Conditions*Please read the below statements and place a checkmark to accept the conditions. I 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 submitting this form I agree that I have been informed that I should not participate in any activity if I have any doubt or if I am uncertain as to my 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 I participate are physically and mentally intense and may require extreme exertion and give rise to the possibility of injury or death. I hereby certify that I am in good health and do not suffer from any heart condition or other ailment that could be exacerbated by the exertion involved in the activities in which I participate. I confirm and agree that I am fully aware of the risk and certify that I am 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 I may sustain or that I have chosen to 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 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 at any class or event. I understand that I will not be compensated in any way for use of any such digital media. I certify that I am at least 18 years of age (16+ with consent from parent). I will bring a Government photo ID to my first training to confirm. I certify that I have a Clear Criminal Record. A Criminal Record Check by the RCMP may be requested at time of registration or any time thereafter. Taka Budo Dokokai Martial Arts Inc. cares about everyone’s safety. Training AgreementTraining Agreement*Please read the below statements and place a checkmark to accept the Training Agreement I wish to participate in the training opportunities offered by Taka Budo Dokokai Martial Arts Inc. and their staff, agents, servants, employees, owners, operators or other representatives (shall herein be known as the “sponsors”). I hereby represent that I am physically and emotionally fit, and I do not have any health conditions which would preclude my participation or engagement in martial arts instructional training. I also acknowledge that the Sponsors are under no obligation to require me to prove my degree of health and fitness for said participation. I hereby acknowledge that I understand that this training will include vigorous physical movement on my part and on the part of my training partners, and with each other, with and without training equipment; it will involve bodily contact with training partners and/or training equipment; and will expose me to the risk of possible serious harm and potentially death. I give full consent to such contact and activity. I further acknowledge that by entering into the training I will be exposed to the risk of bodily injury arising out of possible negligence, unavoidable accident, or otherwise due to the very nature of the martial arts training be taught. I knowingly and willingly assume all risk of injury or other damage involved in or associated with such training activities. I agree and understand that I must report any and all injuries immediately to the Sponsors. For myself and anyone else who might claim on my behalf, I expressly forever release and discharge the Sponsors from all claims, demands, injuries, actions and courses of action, from all acts of active or passive negligence on the part of the Sponsors, their servants, agents or employees. I hereby acknowledge that I fully realize that during training I will and at all times have the options to withdraw from participation in any exercise, training or activity, and that it is my personal responsibility to decide in which techniques, activities and exercises I will participate. I also acknowledge that it is my responsibility to ask questions of the Sponsors to insure that I understand fully how to perform any given technique on a training partner or receive the technique when it is performed on me in a way that I know how to be safe. I will refrain from said involvement in the performance of any given technique or exercise until I am confident in my ability to so do safely. If my conduct, actions or statements while participating in or attending the training are determined to be inappropriate or detrimental to the safety or well-being of other participants or the instructors at the training, I will willingly comply with any request by the Sponsors to remove myself from training activities and from the training venue immediately. I realize and agree to the fact that I will forfeit any pre-paid training fees if requested by the Sponsors to terminate my participation in the training. By signing this agreement, it is my intention to knowingly assume all risks involved in participation or attending this training and to release the sponsors from any responsibilities or liability for any injury I may sustain while participating or training in this martial arts activity. I understand and agree to the fact that Sponsors will not be held liable for any injuries, damages, etc. caused by or resulting from negligence of the Sponsors. I covenant not to sue, and waive and release the Sponsors from any responsibility of personal injury to me. Additionally, I affirm that the Sponsoring venue shall be held free of any and all responsibility or liability for any injuries, damages, etc. resulting from my participation in this martial arts practice. I agree for myself and my successors that the above representations are contractually binding and not mere recitals. That should I or my successors assert any claim in contravention of this agreement, I or my successors shall be liable for any expenses (including, but not limited to, attorney’s fees) incurred by the other parties in defending. This agreement may be modified only by a written amendment signed by both parties. A waiver of any provision of this agreement shall not be construed as a modification or any other provision, or as consent to any other provision, or as consent to any other subsequent waiver modification. This agreement shall be construed and enforced according to the laws of the Province of Saskatchewan, without giving effect to the principles of conflict of law. Training FeeThe regular training fee is CAD 40 per month and provides unlimited training in all our martial arts. Please make note that some weeks have one session, and other weeks may have more sessions. Often ad hoc training is also provided, which is announced in our Facebook group. One-day seminars for members only are sometimes organized, especially during the summer months. As a nonprofit corporation we do not provide refunds. Cancellation of training terms are 30 days.Digital SignatureYour Full Name*Entering your full name here act as a digital signature. You will be asked to sign the printed version of this registration form during your first or next class. First Last Date of Completion* Date Format: DD slash MM slash YYYY This iframe contains the logic required to handle Ajax powered Gravity Forms.