Athlete Information
First Name
First name is required.
Last Name
Last name is required.
Gender
Male
Female
Gender is required.
Date of Birth (YYYY/MM/DD)
Date of birth is required.
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
Level/Rank is required.
Email Address
Email address is required.
Address
Address is required.
City
City is required.
Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Québec
Saskatchewan
Yukon
Province is required.
Postal Code
Postal code is required.
Home Phone
Home phone is required.
Competition Info
Weight (kg) (Mandatory for Kumite) (Optional)
Weight (kg) (Mandatory for Kumite) is required.
Height (Optional)
Height is required.
Experience (years) (Optional)
Experience (years) is required.
Style
Select One
Chito-Ryu
Goju-Ryu
Shito-Ryu
Shotokan
Uechi-Ryu
Wado-Ryu
Kyokushin
Other
Style is required.
Sensei
Sensei is required.
Dojo
Dojo is required.
Events
Kata
Kumite
Para
Kata/Kumite
Events is required.
Goal/Interest
Team Tryout
Open Sessions
Goal/Interest is required.
Emergency Contact
First Name
First Name is required.
Last Name
Last Name is required.
Relationship (Optional)
Please Select One
Mother
Father
Grandparent
Aunt
Uncle
Sibling
Babysitter/Nanny
Spouse/Partner
Relationship is required.
Phone (Cell)
Phone (Cell) is required.
Phone (Home) (Optional)
Phone (Home) is required.
Alternate Email (Optional)
Alternate Email is required.
First Name (Secondary Contact) (Optional)
First Name (Secondary Contact) is required.
Last Name (Secondary Contact) (Optional)
Last Name (Secondary Contact) is required.
Relationship (Secondary Contact) (Optional)
Please Select One
Mother
Father
Grandparent
Aunt
Uncle
Sibling
Babysitter/Nanny
Spouse/Partner
Relationship (Secondary Contact) is required.
Phone (Secondary Contact) (Optional)
Phone (Secondary Contact) is required.
Email (Secondary Contact) (Optional)
Email (Secondary Contact) is required.
Health Information
Health Card #
Health Card # is required.
Expiry Date
Expiry Date is required.
Extended Health Insurance Company Name (Optional)
Extended Health Insurance Company Name is required.
Policy # (Optional)
Policy # is required.
ID # (Optional)
ID # is required.
Have you ever had a concussion?
Yes
No
Have you ever had a concussion? is required.
(If yes, explain: how many, dates and severity) (Optional)
(If yes, explain: how many, dates and severity) is required.
List medical conditions you have and medications you are on (Optional)
List medical conditions you have and medications you are on is required.
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