Kyousai 2020: Inscription Form
Please fill-in the blank spaces bellow.
You are a ?
*
A parent of a child ? (5-12 years)
A parent of a teen ? (13-18 years)
An adult ? (18 years and +)
A director of a Dojo ?
Complete name of the participant
*
First name
Last name
Date of birth of the participant
*
-
Jour
-
Mois
an
Date
Belt
Kyu
Dan
Belt rank
1
2
3
4
5
6
7
8
9
10
Name of the caretaker parent (children and teen, 5-18 years)
First name
Last name
Complete address of the participant
*
Address and street
City
Nom du Dojo
Postal Code
Telephone
-
Area code
Telephone
Email
*
Information on the dojo
Name of the Dojo
Name of the Sensei / Shihan
Address of the dojo
Address
Adresse de la rue (2ème ligne)
City
État/Région
Code Postal
Other Information we need to know ?
Clic here to continue and choose a package
Proposed package for Saturday 8 of February 2020:
*
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( X )
Children and morning training
$
25.00
CAD
Teen or Adult, training in PM
$
45.00
CAD
Total
$
0.00
CAD
Credit Card information
* My choice of meal for the dinner:
Beef Curry
Teriyaki Shrimp
Salmon
Accommodation (pasta)
i have allergy/intolerance to certain food:
If Yes, please tell us which one
Please verify that you are human
*
Send the form and proceed to payment
Should be Empty: