Confirmation – Belt Test

Osu!

You have been invited to participate in a Belt Promotion Test organized by Montreal Kanreikai Karate dojo.

Please make sure to confirm your participation in this test as soon as possible by filling out and submitting the form below.

NB: A parent must fill out this form for a student aged 17 or under.

"*" indicates required fields

BELT PROMOTION TEST - WORLD KANREIKAI KARATE - PIERREFONDS

First Name of Candidate*

Last Name of Candidate*

Email of Candidate - or parent if the candidate is aged 17 or under*

A confirmation email will be sent to this address.

Belt Test Level - Promotion Fee*

Select the test level from the dropdown list

Age Category of the Candidate*

Parent of the Candidate*

The parent must fill out this form in the name of the candidate aged 17 or under.

Realease of Liabilities - Belt Promotion Test organized and supervised by Arts Martiaux Yukan and World Kanreikai Karate

I acknowledge that the risk of injury is inherent in the practice of any martial art and I take full responsibility for any damage, injury or other offense that I may suffer or inflict during this karate test. --- I waive any legal action or claim against instructors, employees, agents, members or authorized guests of Yukan Martial Arts Inc. and/or World Kanreikai Karate. --- I understand and accept that in the event of injury, the medical care provided to me on site will only be primary care. --- I also agree that the photos and videos taken or made by Arts Martiaux Yukan Inc. and/or World Kanreikai Karate as part of this test, as well as my name, may be used by and/or for Arts Martiaux Yukan Inc. and/or World Kanreikai Karate. ______ I have read the above statement. I understand its meaning, and willingly accept this disclaimer on my behalf or on behalf of my child aged 17 or under. --- I therefore confirm my participation - or that of my child aged 17 or under - in this Belt Promotion Test.*

Yes

BELT TEST PROMOTION FEE

Amount to pay (including taxes)

I agree that the promotion fee indicated above will be automatically charged to my account (credit card) on the day of the test.*

Yes

STATUS AS A STUDENT-MEMBER OF WORLD KANREIKAI KARATE

I confirm my current status as a student-member of the World Kanreikai Karate Organization - or that of my child aged 17 or under. Otherwise, I agree to register myself - or my child aged 17 or under - as a student-member of World Kanreikai Karate and to pay the annual subscription fee of $25 before this Belt Promotion Test takes place.*

Yes

Feel free to ask us for any INFORMATION regarding the registration as a student-member of World Kanreikai Karate.

YOUR MESSAGE, IF DESIRED

PLEASE VERIFY YOUR INFORMATION BEFORE SUBMITTING THIS FORM

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Confirmation – Belt Test

BELT PROMOTION TEST - WORLD KANREIKAI KARATE - PIERREFONDS

Realease of Liabilities - Belt Promotion Test organized and supervised by Arts Martiaux Yukan and World Kanreikai Karate

PLEASE VERIFY YOUR INFORMATION BEFORE SUBMITTING THIS FORM

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