Dynamic Karate Fall Clinic 2021
Sign in to Google to save your progress. Learn more
Dynamic Karate 12th Annual Fall Clinic
Event Times:
- Friday September 24. 6:00 - 7:20 PM MST (Family Class), 7:30 - 9:00 (Adult All Ranks)
- Saturday September 25. 9:00 - 10:20 AM MST (White - Orange), 10:30 - 12:00 (Green - Brown), 12:15 - 2:00 (Brown - Black)
- Sunday September 26. 3:00 - 6:00 PM MST (World Traditional Karate Association Black Belt Grading)

Contact Darren at 403.671.5662 or darren@dynamickarate.ca
Name *
Email Address *
Club *
Rank *
Clinics To Attend ** Note - family maximum for the weekend is $25. *
Attendance Preference. ** Friday Adult and Saturday Black Belt Classes are full for in-person training. *
Payment Method *
*** Please read carefully before signing: all participants are required to have this form properly completed and on record with club instructors. ***

In consideration of the benefits received by me and of permission granted now or in the future to participate in Shintani Wado Kai Karate Federation training, I agree and acknowledge that:
1) I have met all of the prerequisites and conditions required for participation in karate.
2) I will abide by the rules and decisions imposed on the participants of this Karate program.
3) I recognize there are risks and hazards inherit in the very nature of the Karate and that as a result of these risks and hazards, I, as a participant may suffer accident, personal injury including death, as well as loss or damage to personal property. I nevertheless freely and voluntarily assume the aforesaid risks and hazards and accordingly my participation in
the Karate shall be entirely at my own risk.
4) I agree now and in the future to indemnify, hold and save harmless from any claim (including medical expenses), liability, suit, action or other proceeding of any kind arising from my participation in Karate training. Dynamic Karate Assoc. Of Alberta and their officers, agents, employees, instructors, fellow participants or authorized guests.
5) The Karate officials may secure such medical advice and services as they, in their sole discretion, may deem necessary for my health and safety and I shall be financially responsible for such advice and services.
6) This INFORMATION, WAIVER OF CLAIM and ASSUMPTION OF RISK is binding on myself, my heirs, my executors, administrators, personal representatives and assigns.

Dynamic Karate Association promotes our activities & celebrate club and individual achievements. Dynamic Karate is built upon its membership. We will use photos or videos to promote Dynamic Karate, the Shintani Wado Kai Karate Federation and the World Traditional Karate Association.

Completing this form confirms your consent in having your name, photos and videos in any promotions.

I hereby give permission to Dynamic Karate.

*** If the participant is under the age of eighteen (18) years, a parent or legal guardian must sign; no other signature will be accepted. ***
Consent Agreement *
Date *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Dynamic Karate Association. Report Abuse