Register for Karate Classes in Regina | Shotokan Karate Regina

Section 1: Personal Information

1. Full Name2. Date of Birth3. Age

4. Gender

MaleFemalePrefer not to say

5. Phone Number6. Email Address7. Home Address8. Emergency Contact Name9. Emergency Contact Phone10. Parent/Guardian Name (if under 18)

Section 2: Background Information

11. Have you participated in similar programs before?

YesNo

12. What motivated you to join this program?13. How did you hear about us?

Section 3: Health & Safety

14. Do you have any medical conditions, injuries, allergies, or physical limitations we should be aware of?15. Are you currently taking any medication that may affect participation?

Section 4: Expectations

16. What are your goals for joining this program?17. What do you hope to achieve within the next 3–6 months?

18. Are you willing to attend classes regularly and follow program requirements?

YesNo

Section 5: Terms & Conditions

Please review our Liability Waiver, Refund Policy, Privacy Policy, and Photo and Video Consent. Your form, including health information, will be transmitted by FormSubmit to the academy email address.

I confirm that all information provided is accurate.I understand that participation involves physical activity and inherent risks.I agree to follow all rules and safety guidelines.I authorize emergency medical treatment if necessary.I grant permission for photos/videos to be used for promotional purposes. (Optional)I understand registration fees are non-refundable unless otherwise stated.

Liability Waiver

I voluntarily participate in this program and assume responsibility for associated risks.

I have read and agree to the Liability Waiver.

Final Consent

Enter your full name in the signature field to sign this form electronically. A parent or guardian must also complete and sign this section for participants under 18.

Participant NameParticipant SignatureParent/Guardian Name (if applicable)Parent/Guardian Signature (if applicable)Date

Student Registration & Enrollment Form