Online Program Registration | Bushido Kai Canada

Student Information

Student Name*

First Last

Phone*

Email*

Date of Birth*

MM

DD

YYYY

Required if under 18.

Address*

Street Address City Province Postal Code

Please list any physical conditions or concerns:

Parent/Guardian Name (if under 18)*

First Last

Parent/Guardian Phone

Parent/Guardian Alternate Phone

BKC Programs

Please Select A Program*

Tiger Tots (Ages 4 to 6)
Karate - Kids (Ages 7 to 12)
Karate - Adults (Ages 13+)
Other Program - Fee Payment

Other Programs*

Private coaching, Special Event Seminar, Self Defence Workshop

Please Select Day for Tiger Tots Program:*

Monday (July & August ONLY)
Saturday (September - June)

Please Select A Billing Option*

Tots - New Student Special
Kids/Adult - New Student Special
3 Month Membership (Prepaid -discount applied)
Pay by Month Membership

Please Select A Term Duration*

Tots - New Student Special - 2 months
Kids/Adult - New Student Special - 2 months
3 Month Membership (PrePaid)
Pay by Month Membership

What is your desired start date?*

MM

DD

YYYY

Note:

You will be invoiced upon submission of registration form. Credit Card payments may be made directly from invoice or contact us at (204) 990-7887. You may mail or drop-off payment anytime at the Academy. Please consult our Class schedule for the Academy hours of operation.
Family discount: 10% off with 2 members, 20% off 3 members

Terms & Conditions

I enter into this Agreement with Bushido-Kai Canada Inc., (thereinafter referred to as “Bushido-Kai Canada”) and do hereby agree, on behalf of myself, my children and all persons who become entitled to use the facilities of Bushido-Kai Canada Karate Academy by virtue of my membership, as follows:

WAIVER AND RELEASE: I, and my child(ren) fully recognize the risks of injury inherent in participating in any martial arts program. I understand the risks inherent in any martial arts training or physical fitness program and I accept these risks as my own personal liability. I affirm that we have taken all reasonable steps to determine that we are in good health and physically capable of participating in the programs and courses of instruction offered by Bushido-Kai Canada Karate Academy.

We acknowledge that Bushido-Kai Canada shall make no, and shall have no responsibility to make any independent evaluation of our physical health or fitness. We understand and agree that all participation in any such fitness program or use of Bushido-Kai Canada’s facilities or equipment on or off the premises of Bushido-Kai Canada shall be at our own risk.

We hereby release, indemnify, and hold harmless Bushido-Kai Canada, Bushido-Kai Canada Inc., and it’s officers, directors, employees and agents, from and against any and all claims, demands, damages, costs and liabilities of any kind or nature to myself or my child (ren), or any person or persons who become entitled to use the facilities of Bushido-Kai Canada by virtue of our membership.

We understand and agree that Bushido-Kai Canada shall not be responsible for the conduct of other users of Bushido-Kai Canada or its facilities or equipment, or participants in Bushido-Kai Canada’s off-premise programs, or for any injury or damage to property resulting from such conduct, and we shall not bring any action or proceeding against Bushido-Kai Canada for any payment compensation or claim for any injury cause by any such user.

I, the undersigned, agree to keep in in good standing the payments for the full duration of this contract. I am fully aware and understand that memberships are non-refundable nor transferable. I hereby assume all responsibility for the full payment terms of this membership and subsequent renewals.

Signature*

Print your full name to indicate that you accept terms and conditions.

Today's Date*

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DD

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Phone

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