Tatsumaki Aikido Registration

Email address *
Last Name *
Your answer
Nick Name
Your answer
First Name *
Your answer
Street Address *
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City *
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State
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Zip Code
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Phone number *
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Ok to email you announcements including class cancellations and seminars? *
Date of Birth *
MM
/
DD
/
YYYY
Occupation
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How did you hear about Tatsumaki/KSU Aikido?
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Do you have any previous Martial Art experience?
(Please describe level of experience including any rank or certifications)
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Do you have any injuries/limitations that we need to be aware of?
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Are you a student in an educational institution? *
If you are marked as a student, when do you expect to graduate?
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone(s) *
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Physician Name
Your answer
Physician Phone
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Visitors, what is your home dojo?
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I am voluntarily participating in the practice of aikido and agree by participating that I will be exposed to risks and hazards expected with a martial art. I agree to be responsible for any inuury or other loss that I may receive while participating. I understand fully, and without reservation agree to forever release the instructors, participants, and officials of Tatsumaki Aikikai and Aikido of Kansas State University from liability for any and all claims and injuries, damages, and losses as a direct or indirect result of participating in aikido practice. I have read and understood the terms and conditions of this agreement, and by filling in the box with my full name I am agreeing to abide by these terms. (If the applicant is under 18 years of age, this field is to be filled by a parent or guardian in front of a Tatsumaki Aikikai representative). *
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