Confirmation – Black Tip/Belt Test

Osu! You have been invited to participate in a Black Tip/Belt Promotion Test organized and supervised by World Kanreikai Karate.

Please confirm your participation in this test as soon as possible by completing and submitting the form below. The promotion fee corresponding to the Tip/Belt level targeted will be charged to your Montreal Kanreikai Karate account one week before the day of the test.

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

World Kanreikai Karate's Black Tip/Belt Promotion Test

Sunday, June 11, 2023
Montreal Kanreikai Karate Dojo
4830, boul.St-Charles, Pierrefonds, QC, Canada - H9H 3E1

First Name of Candidate(Required)

Last Name of Candidate(Required)

Email of Candidate - or parent if the candidate is aged 17 or under(Required)

A confirmation email will be sent to this address

Test Level - Promotion Fee(Required)

Select the test level from the dropdown list

Age Category of the Candidate(Required)

Parent of the Candidate(Required)

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

RELEASE OF LIABILITIES - BLACK TIP/BELT PROMOTION TEST ORGANIZED AND SUPERVIZED 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.(Required)

Yes

TEST PROMOTION FEE

Amount to pay (taxes included)

I agree that the above promotion fee will be charged to my Montreal Kanreikai Karate account (credit card) one week before the day of the test.(Required)

Yes

YOUR MESSAGE, IF DESIRED

PLEASE VERIFY YOUR INFORMATION BEFORE SUBMITTING THIS FORM.

CAPTCHA

Confirmation – Black Tip/Belt Test

World Kanreikai Karate's Black Tip/Belt Promotion Test

RELEASE OF LIABILITIES - BLACK TIP/BELT PROMOTION TEST ORGANIZED AND SUPERVIZED BY ARTS MARTIAUX YUKAN AND WORLD KANREIKAI KARATE

PLEASE VERIFY YOUR INFORMATION BEFORE SUBMITTING THIS FORM.

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