Dynamic Karate Registration - Fall 2022
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Dynamic Karate Student Registration
Class Times:
       - Mondays 6:30 - 9:30 PM (Tuscany - Twelve Mile Coulee School)
       - Wednesdays 6:30 - 9:00 (Tuscany - Eric Harvey School)
       - Fridays 5:00 - 6:00 (Tentative Virtual Online - Kicking Class)

Contact Darren at 403.671.5662 or darren@dynamickarate.ca 

First Name *
Last Name *
Full Name
Date Of Birth *
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Address *
City *
Postal Code *
Email Address *
Phone Number *
Club *
Required
Class Fees *
Required
Uniforms & Equipment
Total Paid (** eTransfer to darren@dynamickarate.ca). Payment is due your first class. Email: info@dynamickarate.ca or darren@dynamickarate.ca *
Payment Method *
Medical Information. Please provide any medical information the instructors should beaware of. *
PARTICIPANT INFORMATION, WAIVER OF CLAIM, & ASSUMPTION OF RISK
*** 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 take every precaution to ensure COVID protocols are being followed. I understand that the Shintani Wado Kai Karate Insurance does not cover COVID.
3) I will stay home if I am not feeling well.
4) I will abide by the rules, regulations and decisions imposed on the participants of this Karate program.
5) 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.
6) 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.
7) 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.
8) This INFORMATION, WAIVER OF CLAIM and ASSUMPTION OF RISK is binding on myself, my heirs, my executors, administrators, personal representatives and assigns.
9. I freely and voluntarily assume any risks and hazards inherit to Karate and, accordingly, the participation in Karate shall be entirely at his/her own risk.
10. Will waive any claim against the Dynamic Karate Association of Alberta and the facility of training arising from participation in Karate and agree to indemnify and save harmless the Dynamic Karate Association of Alberta for any, including any claim for medical services arising from the participation in Karate.
11. The Dynamic Karate Association of Alberta may secure such medical advice and services as it, in its sole discretion, may deem necessary for the health and safety and shall be financial responsible for such advice and services.
12. This waiver of claim is binding on the participants, their heirs, executors, administrators, personal representatives and assigns.
13. Pictures may be taken during classes, workshops, tournaments or other functions for the purpose of advertising which may include the Dynamic Karate Association of Alberta’s website or other Association marketing materials. Students acknowledge and agree that their photos can be used for this purpose.
14. The Dynamic Karate Association of Alberta is collecting this information in accordance with the Personal Information Privacy Act (2003).  We will use this information to maintain membership lists under the requirements of the Societies Act (1980), to provide phone/email lists to members, to contact members with information about the club, the Shintani Wado Kai Karate Federation, the World Kobudo Federation, and the World Traditional Karate Association Of Canada, in the event of an emergency.  We will not share this information with any third parties without prior written consent.  By signing this form, you consent to this use of the information you provide.

I hereby give permission to Dynamic Karate Association of Alberta, Shintani Wado Kai Karate Federation, World Traditional Karate Association and the World Kobudo Federation

*** 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 *
Required
Signature (Parent if Under 18) *
Date *
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Time
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