2022 Seiyu Summer Camp Registration Form (Youth 14 to 18)

Did you receive Shihan Tats’ approval to participate? *

Yes

Please ask him by email at vkk@shaw.ca before filling out this form!

Event Details

When: August 19 to 21 2022

Where: Loon Lake Lodge & Retreat Center, 14500 Silver Valley Road, Maple Ridge, British Columbia, V4R 2R3.

Who can attend: Seiyu members, all belt ranks, and 14 & over (A child who is accompanied by a black belt parent can participate even if they are under 14.)

Instructors: Seiyu Karate Instructor Team

Activities: A minimum of six (6) training sessions (which include indoor seminars, water training, and outdoor training)

More Information: www.fightingart.ca

Registration Fees (Youth 14 to 18):

On or before June 30th: $240
After June 30th: $260

Registration Information

Name *

Age *

Phone Number *

Email Address *

Address *

IKON Membership Number (Type 000 if your child has not received a card yet.) *

Emergency Contact Person Name (in case of emergency such as a participant showing Covid-19 symptoms during the class) *

Emergency Contact Cell Phone Number *

2022 Summer Camp T-Shirt Size *

Small (Teens / Women)

Medium (Teens / Women / Men)

Large (Teens / Women / Men)

X-Large (Women / Men)

Food Allergies or Restrictions (Please list food allergies and restrictions if the student has any)

How to get to the camp *

I will drop off my child at the camp and pick them up later

My child needs a ride

My child needs a ride but has already found one

Can you give other participants a ride to the camp? (Please take their luggage into consideration! You will also be responsible for their ride back from the camp.) *

Yes

How many participants can you give rides to? *

Do you consider your child a light sleeper or a heavy sleeper?
- Light sleeper: Snoring bothers you a lot
- Heavy sleeper: You can handle snoring to a certain extent *

I think my child is a light sleeper

I think my child is a heavy sleeper

I’m not sure

SEIYU KARATE GENERAL WAIVER AND FORM AND PHOTO & VIDEO RELEASE

Youths Ages 14 to 18

Nature of Activity: This permission slip will cover the Seiyu Karate Summer Camp Event of 2022

Date of Activity: August 19 - 21, 2022

Means of Transportation: Transportation is the responsibility of the student attending. There will be a number of Seiyu Members attending who may be able to assist with travel to and from this event.

Methods of Supervision: Students who are 18 years of age and under will be supervised by Seiyu Adult members.

Location of Activity: Loon Lake Lodge & Retreat Center, 14500 Silver Valley Road, Maple Ridge, British Columbia, V4R 2R3.

NAME OF STUDENT *

I have read and understood the camp rules and expectations listed on the website. https://www.fightingart.ca/registration-summercamp

I hereby give my permission for my child to take part in the activity as outlined above, and hereby agree as well and sufficiently indemnify and save harmless Vancouver Seiyu Karate and keep Vancouver Seiyu Karate indemnified and harmless of any and all demands, actions, proceedings, liability claims, damages, together with the costs and expenses thereof, that may hereafter at any time be made or brought by or on behalf of my child for any injury, loss, damage, expense and costs sustained or alleged to have been sustained by my child howsoever arising from the aforesaid activity provided.

I hereby authorize Vancouver Seiyu Karate to use the image of my child taken during the event in its public relations and communication materials to promote Vancouver Seiyu Karate.

NAME OF PARENTS/GUARDIAN *

SIGNATURE OF PARENTS/GUARDIAN *

clear

Youth Summer Camp Registration Fees *

Youths 14-18 ($260)