Beginner Registration • Shū Ken Kai Iaido Dojo, 秋剣会

First Name

Last Name

Date of Birth

Email Address

Address

Phone Number

Emergency Contact

Emergency Contact Phone Number

COVID-19 Vaccination

Waiver of Liability

I, the undersigned, intending to be legally bound, do hereby, for myself, heirs, executors and administrators, waive, release and forever discharge any claims for damages which I may incur (which may include severe injury or death), or which may hereafter accrue to me, against the Shuu Ken Kai Dojo, the Pacific Northwest Kendo Federation and/or the All United States Kendo Federation along with their members and agents for all or any damages which may be sustained or suffered by me in connection with my participation in activities of the Shuu Ken Kai Dojo, or arising out of transportation to and from the sites for activities of the Shuu Ken Kai Dojo or its parent organization(s). Where the participant is a minor, I, the parent or guardian do agree to the above waiver and give permission to the Shuu Ken Kai Dojo or other authorities to seek medical attention for my child in the event of sickness or injury.

Once you have submitted your registration form, please click here to continue to payment.

NOTE: Your registration will not be finalized without payment