WKA Canadian Nationals Registration & Payment

Competitor's Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Gym Name

City

Province

Muay Thai & Kickboxing Record

Total Number of Fights

Age

Weight Class

Sex

Categories

Calculation

WKA Nationals Rules

Waiver
I, the undersigned, do hereby voluntarily submit my application for attendance and participation and do hereby assume full responsibility for any and all damages and/or injuries that I may sustain or incur, if any, while attending or participating in the mentioned event – WKA Canadian Nations. I hereby waive all claims against the promoters Vanessa Bellegarde & The Airdrie Martial Arts Centre, or sponsors of said tournament, individually or otherwise, for any damages, injuries, or losses that I may sustain or incur. I fully understand that any medical treatment given to me will be of the first aid type only. I consent that any pictures furnished by me or any pictures taken of me in connection with the said tournament can be used for publicity, promotion, television show, or websites, now or in the future, and I waive compensation in regard thereto. I have read and fully understand the above waiver. (If under the age of 18, this form must be signed by a parent or guardian.)

Competitor or Parent/Guardian Signature:
Signature*
Date:
Date* .

Payment Amount

CADWKA Canadian Nationals 2026

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Please verify that you are human

Payment Amount*

Payment Amount