2024 Seiyu Summer Camp Registration Form (Adults 19 or Over)

Event Details

When: August 16 to 18, 2024

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

Who can attend:
- Active Seiyu members who attend our adult class

Instructors: Seiyu Karate Instructor Team

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

More Information: www.fightingart.ca

Registration Fees (Adults ages 19 and up):

On or before June 30th: $292
After June 30th: $317

Registration Information

Name *

Age *

Phone Number (Enter as 10 digits without any hyphens or brackets) *

IKON Membership Number (Type 000 if you have not received a card yet.) *

Address *

Email Address *

Emergency Contact Person Name *

Emergency Contact Cell Phone Number *

2024 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 drive to the camp

I don’t have a vehicle and I need a ride

I don’t have a vehicle but I have already found a ride

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 yourself 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 I’m a light sleeper

I think I’m a heavy sleeper

I'm not sure

SEIYU KARATE GENERAL WAIVER AND FORM AND PHOTO & VIDEO RELEASE

Ages 19 and over

Nature of Activity: This general waiver will cover the Seiyu Karate Summer Camp Event of 2023

Date of Activity: August 16 - 18, 2024

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.

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

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 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 sustained or alleged to have been sustained howsoever arising from the aforesaid activity provided. I hereby authorize Vancouver Seiyu Karate to use the image of me taken during the activity in its public relations and communication materials to promote Vancouver Seiyu Karate.

NAME *

SIGNATURE *

clear

Adults Summer Camp Registration Fees *

Student 19 & Over ($292)