Winter Camp 2011, Application

Kuma Dojo Association Karate-Do International

Summer Camp 2012

Name:________________________________________________________________________________

Address:______________________________________________________________________________

Address:________________________________________________________Phone:________________

Email:____________________________________                                                                                                                                                                                                                                     

Web Site:__________________________________

KDA Membership number _______________

Grade:_____________________________ Years training:____________________

Age:_______________________

Dojo Name:____________________________________________________________________________

Dojo Owner:________________________________________________________________________________

Address:______________________________________________________________________________

Address:______________________________________________________________________________

Phone:_________________________________                                                                                                                                                                                             

Email:______________________________________

I fully understand that I____________________________________________ will be attending a training camp for Karate and that during my training injuries may accrue.                                       During this time that I am attending this  Karate training with the  Kuma Dojo Association Karate-Do International (KDA), I shall not hold anyone associated with KDA or the facility KDA it is using {Ichban Dojo} at fault or blame for any injuries that may occur during the travel to and from the training or during the training or warm-ups, cool downs or any time during my training 2011.

I,_____________________________________________ also understand that as a KarateKa (person who trains in the Martial Arts) I am aware of my bodys limits and body's injuries coming into this event/traing camp, and that I as an adult and highly trained KarateKa know when to stop before injuries occur, or any further pre exsisting injuiries/damage are further injuired to the area(s) thatwhere injuired before you attended summer camp, or to ask that actions be stopped before injuries occur.

I also understand that pictures of this event/traning camp will be taken and I__________________________________________ give KDA permission to use or post my photo (name ) or likeness on their web site or future fliers and events media publications. 

Yudansha's Signature 18 and older:_____________________________________________________________________________

Legal Guardian under 18:_____________________________________________________________________________

Date:________________________________________________

Make bank check out to  John Farrell

Members $50

Non Members $75

Yudansha tesing $100.00

Mail To:

KDA C/O John Farrell

1116 Largo Way

E. McKeesport, PA. 15035 USA