Millwoods Karate - Clinic Registration and Waiver

Featuring Special Guest Kathy Long

You’re invited to a special weekend clinic featuring Kathy Long, February 6–7, 2026, hosted by the Millwoods Karate Club. A five-time world kickboxing champion and internationally respected martial artist and coach, Kathy will be leading practical self-defense training, drawing on her elite fighting experience and deep martial arts background.

Known for her technical precision and ability to translate high-level combat principles into clear, accessible instruction, this high-energy clinic offers a rare opportunity to learn from one of the most accomplished figures and instructors in modern martial arts.

Adult participants are recommended to wear groin protection.

** OPEN TO ALL RANKS**

Clinics

Friday Feb 6, 2026
Youth: 6:00-7:30 (12 years and under)
Adult: 7:30-9:30 (13 years and older)

Saturday Feb 7, 2026
Adult (13 years and older): 9:00-4:00
half hour break for lunch. (Please bring a light lunch)
Evening Banquet; Location TBD

LOCATION
Crawford Plains School Gym
4210 12 Ave N.W.
Edmonton, AB

FEES
Youth Clinic (12 years and under): $25.00;
Adult Clinic (13 years and older): $70.00
e-transfer to: mwkarateclub@gmail.com
Clinic Registration and Waiver

WARNING!

BY SIGNING THIS FORM YOU GIVE UP IMPORTANT LEGAL RIGHTS INCLUDING THE RIGHT TO SUE

PLEASE READ CAREFULLY!

*** One registration per person ***
Email*
example@example.com
Participant name*

First NameLast Name
Date of birth (DOB)*

MonthDayYear
Date
Age in Years
not seen on form - age in years
Current belt rank*
Shintani passbook number
Home Dojo*
Home dojo - other*
Phone Number*
Please enter a valid phone number.
Special health considerations
Emergency contact name

First NameLast Name
Emergency contact phone
Please enter a valid phone number.
Registration fees*
This will populate with the fee based on the participant age
MKC Clinic Fee Rebate
Millwoods Karate Students $25 registration fee reduction
Total fee
Please DO NOT update this field - it is calculated
Payment method*
*** e-transfer to mwkarateclub@gmail.com - when paying by e-transfer add the participant(s) name(s) to the memo section ***
e-transfer verified
cash receipt or cheque number
I hereby apply TO PARTICIPATE in the Millwoods Karate Club (MKC) and the Shintani Wado Kai Karate Federation (SWKKF) sanctioned CLINIC on the dates above. I agree to observe all the club rules and regulations and to respect the requests of instructors established for the purpose of maintaining order and protecting members from injury. I acknowledge that while MKC strives to provide a safe training environment, karate is an activity that involves risk, including possible rosk of severe or fatal injury. I further waive any legal rights in travel to and from said event. I further agree that the members' likeness may be used in promotional media. I, and my heirs and successors, release Instructors, the Directors and other members of the MKC, the SWKKF and Edmonton Public Schools FROM ANY AND ALL LIABILITY for any injury, damage, loss, or expense that I may suffer while participating in the club activities.
Privacy Policy

The Millwoods Karate Club (MKC) and the Shintani Wado Kai Karate Federation (SWKKF) are Collecting this information in accordance with the Personal Information Privacy Act (2003). This information will be used for participation lists under the requirements of the Societies Act (1980), to contact SWKKF members about other club events and in the event of an emergency with a member herein participating. This information will not be shared with any third parties except in case of medical emergency without prior written consent. By signing this form, you consent to this use of information you provide.
Dated at Edmonton, AB on this day*

MonthDayYear
Date
Hour Minutes
Participant signature (Parent or Legal Guardian if under 18 years old)*

Clear

Millwoods Karate Club

INFORMED CONSENT AND ASSUMPTION OF RISK AGREEMENT

WARNING! By signing this document, you will assume certain risks and responsibilities. Please read Carefully
Participant name*

First NameLast Name
1. This is a binding legal agreement. Clarify any questions or concerns before signing. As a Participant in the sport of Karate and the orientation, instruction, activities, programs and services of Karate (collectively the "Activities"), the undersigned, being the Participant and the Participant's Parent/Guardian (Collectively the "Parties"), acknowledge and agree to the terms outlined in this document:

Disclaimer

2. MILLWOODS KARATE CLUB, its directors, officers, committee members, members, employees, coaches, volunteers, officials, participants, agents, sponsors, owners/operators of the facilities in which the Activities take place, and representatives (collectively "The Organization") are not responsible for any injury, personal injury, damage, property damage, expense, loss of income or loss of any kind suffered by the Participant during, or as a result of, the Activities, caused in any manner whatsoever including, but not limited to, the negligence of the Organization.
We have read and agree to be bound by paragraphs 1 and 2*
initials of participant (or parent or legal guardian)
Description of Risks

3. The Parties understand and acknowledge that:
1. The Activities have foreseeable and unforeseeable inherent risks, hazards and dangers that no amount of care, caution or expertise can eliminate, including without limitation, the potential for serious bodily injury, permanent disability, paralysis and loss of life;
2. The Organization may offer or promote online programming (such as webinars, remote conferences, workshops and online training) which have different foreseeable and unforeseeable risks than in-person programming;
3. The Organization has a difficult task to ensure safety and it is not infallible. The Organization may be unaware of the Participant’s fitness or abilities, may give incomplete warnings or instructions, may misjudge weather or environmental conditions, and the equipment being used might malfunction; and
4. The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization and COVID-19 is extremely contagious. The Organization has put in place preventative measures to reduce the spread of COVID-19; however, the Organization cannot guarantee that the Participant will not become infected with COVID-19. Further, attending the Activities could increase your risk of contracting COVID-19.
4. The Participant is participating voluntarily in the Activities. In consideration of that participation, the Parties hereby acknowledge that they are aware of the risks, dangers and hazards and may be exposed to such risks, dangers and hazards. The risks, dangers and hazards include, but are not limited to:
1. Contracting COVID-19 or any other contagious disease;
2. Privacy breaches, hacking, technology malfunction or damage;
3. Executing strenuous and demanding physical techniques;
4. Vigorous physical exertion, strenuous cardiovascular workouts and rapid movements;
5. Exerting and stretching various muscle groups;
6. The failure to properly use any piece of equipment or from the mechanical failure of any piece of equipment;
7. Spinal cord injuries which may render me permanently paralyzed;
8. Striking participants and objects with parts of the body;
9. Contact, colliding or being struck by other participants;
10. Tumbling, falling or being thrown to the floor;
11. Serious injury to virtually all bones, joints, ligaments, muscles, tendons and other aspects of my body or to my general health and well-being;
12. Abrasions, sprains, strains, fractures, or dislocations
13. Concussion or other head injuries, including but not limited to, closed head injury or blunt head trauma;
14. Physical contact with other participants, spectators, equipment, and hazards;
15. Not wearing appropriate safety or protective equipment;
16. Failure to act safely or within my own ability or within designated areas;
17. Negligence of other persons, including other spectators or participants;
18. Weather conditions;
19. Travel to and from competitive events and associated non-competitive events which are an integral part of the Activities
We have read and agree to be bound by paragraphs 3 and 4*
initials of participant (or parent or legal guardian)
Terms

5. In consideration of the Organization allowing the Participant to participate in the activities, the Parties agree:
1. That the Participant’s mental and physical condition is appropriate to participate in the Activities;
2. That when the Participant practices or trains in his or her own space, the Parties are responsible for the Participant’s surroundings and the location and equipment that is selected for the Participant;
3. To comply with the rules and regulations for participation in the Activities;
4. To comply with the rules of the facility or equipment;
5. That if the participation observes an unusual significant hazard or risk, the Participant will remove themselves from participation and bring such to the attention of an Organization representative immediately;
6. The risks associated with the Activities are increased when the Participant is impaired, and the Participant agrees not to participate if impaired in any way;
7. That it is their sole responsibility to assess whether any Activities are too difficult for the Participant, By the Participant commencing and Activity, they acknowledge and accept the suitability and conditions of the Activity;
8. That they are responsible for the choice of the Participant’s protective equipment and the secure fitting of the protective equipment;
9. That COVID-19 is contagious in nature and the Participant may be exposed to or infected by COVID-19 and such exposure may result in personal injury, illness, permanent disability or death and voluntarily agree to assume all of the foregoing risks.
6. In consideration of the Organization allowing the Participant to participate, the Parties agree:
1. That the Parties are not relying on any oral or written statements made by the Organization or their agents, whether in brochure or advertisement or in individual conversations, to agree to be involved in the Activities; and
2. That the Organization is not responsible or liable for any damage to the Participant’s vehicle, property, or equipment that may occur as a result of the Activities.
We have read and agree to be bound by paragraphs 5 and 6*
initials of participant (or parent or legal guardian)
General

7. The Parties agree that in the event that they file a lawsuit against the Organization, they agree to do so solely in the Province of Alberta, Canada and they further agree that the substantive law of Alberta will apply without regard to conflict of law rules.

8. The Parties expressly agree that this agreement is intended to be as broad and inclusive as is permitted by law and that if any of its provisions are held to be invalid, the balance shall, notwithstanding, continue in full legal force and effect.
We have read and agree to be bound by paragraphs 7 and 8*
initials of participant (or parent or legal guardian)
Acknowledgement

9. The Parties acknowledge that they have read this agreement and understand it, that they have executed this agreement voluntarily, and that this agreement is to be binding upon themselves, their heirs, their spouses, parents, guardians, next of kin, executors, administrators and legal or personal representatives.
Participant name*

First NameLast Name
Participant date of birth*

MonthDayYear
Date
Name of Parent or Legal Guardian*
*** if Participant is of Legal Age then re-enter the name of the Participant ***
Signature of Participant (or Parent or Legal Guardian)*

Clear
*** if Participant is not of Legal Age then must be Parent or Guardian ***
Date signed*

MonthDayYear
Date
Hour Minutes
Should be Empty: