SKIF Karate-Do Learning and Training Seminar

JULY 26/27 2008  Rochester, NH  Dojo

Costs will be $75.00 for both days, all three sessions.  $50.00 for either Saturday or Sunday. Students 15 years and younger $25.00 for Saturday...$40.00 for both (students must be Blackbelt level for Sunday).

REGISTRATION FORM

Name ________________________________________________________________________

Address:  _____________________________________________________________________

Phone:  _____________________________   SKIF-USA Membership #:  __________________            

Home Dojo:  _________________________    Rank:  ___________________________________            

Adults                                                                                                Youth (15 years and younger)

______ 2 Days (3 sessions) :  $75.00                                         ______ 2 Days (3 sessions); $40.00

______ 1 Day  ___ Saturday; ___ Sunday ($50.00)                ______ 1 Day  ___ Saturday; ___ Sunday ($25.00)

Make payment to:        Maine Shotokan Karate Association

                                        PO Box 549, Farmington, ME 04938
 

Participation Waiver & Release

I, (Print Name)__________________________, intend to participate in the above open Karate-do Learning and Training Seminar sponsored by New England Shotokan Karate-do, Maine Shotokan Karate Association and/or Rochester Shotokan Karate Club. I hereby acknowledge that there are possible risks of bodily injury involved in participating in the special training and related activities.  I hereby accept such risks and waive and release any and all claims and expenses (including but not limited to attorney fees, claims for damages, medical expenses, litigation and other costs, etc.), either known or unknown, now existing or arising in the future, that I may have of whatever kind or nature against any organizer, director, member, instructor, owner or anyone else involved in any way with this open course and associated activities, including but not limited to SKIF-Japan, SKIF-USA, Glenn Stoddard, New England Shotokan Karate-do, James P. Shea, Maine Shotokan Karate Association, Michael F. Cook, Rochester Recreation Shotokan Karate Club, Steven D. Warren, and/or Rochester Recreation Center, and the City of Rochester, New Hampshire.

I further agree that any pictures taken of or by me in connection with this open Karate-do course may be used for publicity or promotion or for personal use by the organizers of this event without compensation to me.

I fully understand this Participation Waiver & Release and I am signing it voluntarily so that I may participate in the open Karate-do Learning and Training Seminar sponsored by SKIF-USA, Glenn Stoddard, New England Shotokan Karate-Do, c/o James P. Shea, Maine Shotokan Karate Association, c/o Michael F. Cook, and the Rochester Recreation Shotokan Karate Club, c/o Steven D. Warren.

Signature:_________________________________    Date:  __________________________________

Guardian:_________________________________    Date:___________________________________