Athlete Information
First Name
Last Name
Gender
Male
Female
Date of Birth (YYYY/MM/DD)
Level/Rank
10 Kyu
9 Kyu
8 Kyu
7 Kyu
6 Kyu
5 Kyu
4 Kyu
3 Kyu
2 Kyu
1 Kyu
1 Dan
2 Dan
3 Dan
4 Dan
5 Dan
6 Dan
7 Dan
8 Dan
9 Dan
10 Dan
Email Address
Address
City
Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Québec
Saskatchewan
Yukon
Postal Code
Home Phone
Competition Info
Weight (kg) (Mandatory for Kumite) (Optional)
Experience (years) (Optional)
Style (Kata Only)
Select One
Chito-Ryu
Goju-Ryu
Shito-Ryu
Shotokan
Uechi-Ryu
Wado-Ryu
Other
Sensei
Events
Kata
Kumite
Kata/Kumite
Para Kata
Emergency Contact
First Name
Last Name
Relationship (Optional)
Please Select One
Mother
Father
Grandparent
Aunt
Uncle
Sibling
Babysitter/Nanny
Spouse/Partner
Phone (Cell)
Phone (Home) (Optional)
Alternate Email (Optional)
Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe. (Optional)
Health Information
