Student Registration Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Student's Name *FirstLastParent/Guardian Name (if applicable)Email *PhoneEmergency Contact Name *FirstLastEmergency Contact Phone * Name) Contact this Martial Art Enrolled *— Select Choice —Danzan Ryu JutjisuShorin Ryu KarateBothStudent Age Group *— Select Choice —5-1313-1616+Additonal InformationVoluntary Waiver and Release of LiabilityPlease read carefully before agreeing. By checking this box, I acknowledge that I have read, understand, and agree to this waiver. *I AgreeThis agreement is entered into between the undersigned participant, or parent or legal guardian if the participant is under 18, and Daibudō Kodenkan Matsuno Kenshūkai (DKMK), a nonprofit martial arts organization. Participation includes physical activities inherent to martial arts training, including but not limited to throws, falls, strikes, and conditioning exercises.By signing this form, I voluntarily acknowledge and accept the risks inherent in martial arts training and agree to release and hold harmless DKMK, its instructors, assistants, volunteers, board members, the Kodenkan Center, and the Kodenkan Yudanshakai organization from any and all claims or causes of action, whether known or unknown, arising out of participation. I authorize DKMK staff to seek emergency medical treatment in the event that I, or my child, am injured and unable to respond. I further agree that this waiver is binding upon my heirs, executors, administrators, and assigns. If the participant is under 18, this waiver is executed by a parent or legal guardian on the participant’s behalf. Electronic Signature (Type Full Name) *Parent or legal guardian must sign for participants under 18.Submit
