Grand River Aikido Registation Form
Registration and Waiver of Liability
Registrant's Full Name *
Enter Full Name
Your answer
Which Class Is Registrant Joining?
Select Class
Age Of Registrant *
Enter Age
Your answer
Email Address *
Enter Valid Email
Your answer
Email belongs to *
Required
Phone Number *
Enter Your Phone Number
Your answer
I assert that I/Registrant is in good health and able to participate in moderate to high physical exercise. *
If NO you are not eligible to enter into an agreement with Grand River Aikido
I am 18 years or older *
Define Your Status *
Define Your Relationship To Registrant
If Parent\Guardian enter your full name
Your answer
I/We release Grand River Aikido, Ontario 2456375 and Lee Darke and it and his employees, agents and volunteers, its representatives elected or employed and its members, officers, directors, employees, agents, associations and volunteers,(“Releasees”) from all liability, recourse, proceedings, claims, and causes of action of any kind whatsoever, in respect of all damages, personal injuries, death or property losses (“Loss” or “Losses”) which I/we may suffer arising out of preparation for or participation in the Grand River Aikido (“Participation”), notwithstanding that any Loss was caused solely or partly by negligence of any Releasee. *
Agree To Release Of Liabilty. If NO you are not eligable to enter into an agreement with Grand River Aikido
Additonal Information
Please enter any additional information or medical conditions the Dojo should be aware. Keep in mind privacy. If you need to disclose personal information that is highly sensitive, then speak to Sensei Lee directly.
Your answer
Can we add you to our email list?
The email list will be used for all important Dojo updates and to communicate information about cancelled classes etc.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms