Students 19 and over attending Class 4 / 5 / 6

Student 
Classes to Attend per week *
Please select one class *
Please choose two classes to attend *
Acknowledgment of Risk, Waiver, and Release / Photo Release Form for students 19 and over
I hereby consent to photography, recording, reproduction, and any other manner (including use of video and audiotapes) of the likeness, voice and/or activities of me and further authorize Vancouver Seiyu Karate Inc. to make unlimited use of company promotions, including but not limited to broadcasting or reproductions over the radio, television, and on the Internet (including social networking). I do hereby release and hold harmless Vancouver Seiyu Karate Inc, its officers, instructors, and employees from any claims.
 
I have read and understood all of the above terms and conditions including the guidelines listed on the web site. I have chosen to register myself to participate in the online program and I understand there are risks involved in any physical activity. I, therefore, agree to not hold any sponsors, organizations, or individuals responsible should any injury of any nature occur while taking part in this online program.
Signature *
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Train Online Pricing *
Train Online Pricing *