Registration Form

2024/2025 Registration Form

Regina Y Judo Club
Participant Info
Name

First NameLast Name
Birth Date

MonthDayYear
Gender
Belt Rank
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Notes for the coaches about this athlete (health, behavior, motivation,...)
Contact info
Primary E-mail
example@example.com
Primary Number
Guardian

NameRelation
Guardian

NameRelation
Class Info
Class Selection
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2024/2025 Registration and Insurance FeesClub Membership - required for all registered class options. Benefits - Free club fun events, reimbursements for select training opportunities, coaching/referee subsidies.
$100.00CAD



Youth Judo - FallBorn 2012-2019 Classes Tue 6:30-7:30 & Thu 7:15-8:15 Season Sept 3-Dec 19 **Note - Fall and Winter sessions may be purchased at the same time to save duplicate registration fees!*
$150.00CAD



Youth Judo WinterBorn 2012-2019 Classes Tue 6:30-7:30 & Thu 7:15-8:15 Season Jan 7-April 29 **Note - Fall and Winter sessions may be purchased at the same time to save duplicate registration fees!*
$150.00CAD



Adult JudoBorn 2011 or earlier Classes Tue/Wed 7:30-9:00, Sat 12:45-2:15, and Sun 1:00-2:00 Season Aug 28 - June 26
$600.00CAD



Drop in DailyA per class option for visitors or low commitment. 10 punch passes also available *Does not include club membership or $100 registration fee*
$10.00CAD Quantity



Total

$0.00CAD
Upon review an invoice will be emailed including any applicable discounts.

Payments available by etransfer, online invoice payment, or by cash, credit or debit in person at the club.
I authorize the Regina Y Judo Club to use photos of myself/my child for educational or promotional purposes in any type of media including its website and social media accounts.

YesNo
I understand that this is a physical sport that contains an element of hazard and, in this respect, I accept the full responsibility fo the presence of this member (myself/my child) in the program, and release the Regina Y Judo Club, its coaches, volunteers, and employees of any and all liability, for any and all damages or injury, however caused. I have carefully read this agreement and fully understand it's contents. I am aware that this is a release of liability and waiver of claims and accept it of my free will.
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2024/2025 Registration Form

Participant Info

Contact info

Class Info