Student Registration

Complete the form below to register for karate classes at Karate Zanshin.

Personal Information

First Name *

Last Name *

Date of Birth *

Gender *

Occupation / School

Contact Information

Street Address *

City *

Province *

Postal Code * Format: A1A 1A1

Country *

Phone Number *

Email Address *

Alternate Phone Number

Emergency Contact

Emergency Contact Name *

Relationship *

Emergency Contact Phone *

Emergency Contact Email

Medical Information

Medical Conditions or Allergies This information is kept confidential and is used only for safety purposes.

Physical Restrictions or Limitations

Karate Experience

Experience Level *

Current Belt Rank (if applicable)

Previous Training Experience

Training Goals

Payment Information

Membership Plan *

Additional Training Options

Private Lesson - $60/30 min

Sparring Program - Add $125/month

Family Plan - Save 10%

Preferred Payment Method

How did you hear about us?

Waiver and Consent

RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT

By signing this agreement, I acknowledge that I have read, understood, and agree to be bound by the following terms:

1. I understand that karate training involves physical activity and may involve risk of injury, including but not limited to sprains, strains, fractures, and other serious injuries.

2. I voluntarily assume all risks associated with participation in karate classes and activities at Karate Zanshin.

3. I release, waive, and discharge Karate Zanshin, its instructors, employees, and agents from any and all liability for any loss, damage, injury, or expense that I may suffer as a result of my participation in karate classes.

4. I agree to indemnify and hold harmless Karate Zanshin from any claims, demands, or actions arising from my participation in karate classes.

5. I understand that I must follow all safety rules and instructions provided by instructors.

6. I consent to the use of my photograph or video for promotional purposes by Karate Zanshin.

7. I understand that membership fees are non-refundable except as provided in the membership agreement.

I have read and agree to the waiver and release of liability *

I consent to the use of my photograph or video for promotional purposes

I would like to receive newsletters and updates about classes, events, and promotions

Additional Information

Additional Notes or Comments

Your information is secure and will be kept confidential