YUSHINKAN DOJO
  • About Us
    • The Dojo Tour
    • Study Group Heads
    • Student Registration
  • Classes
    • Daito Ryu Aiki Jujutsu Study Group
    • Aikido
    • Classical Japanese Sword & Staff
    • Shinkendo
  • Schedule
  • Events
  • Visit Us
  • Pay Online
    • Online Payment
    • Seminar Payment
  • Donate
  • Try a Free Class
  • About Us
    • The Dojo Tour
    • Study Group Heads
    • Student Registration
  • Classes
    • Daito Ryu Aiki Jujutsu Study Group
    • Aikido
    • Classical Japanese Sword & Staff
    • Shinkendo
  • Schedule
  • Events
  • Visit Us
  • Pay Online
    • Online Payment
    • Seminar Payment
  • Donate
  • Try a Free Class

Student Registration Form

If you have already submitted a request for a free trial class or would like to enroll in a normal class, please complete the required form below and hit SUBMIT.

    General Information and Emergency Contact

    Please provide an emergency contact providing name, address, phone number, relation to self.

    RELEASE FROM LIABILITY FORM
    Yushinkan Dojo L.L.C.

    Please complete, sign, and date below.
    I,
    Name of person participating
    (hereinafter “participant”), in consideration of being allowed to participate in classes/activities at Yushinkan Dojo L.L.C. agree to hold harmless Yushinkan Dojo L.L.C., their members, agents, employees/instructors, successors and assigns from and against any personal injury, death or property damage that may result because of my participation in any/all Yushinkan Dojo L.L.C. activities. I fully comprehend and agree that there are inherent risks involved with any physical activity, especially martial arts, and I assume all risks of personal injury, including death, resulting from my participation.  I further state that I have no known physical or mental health limitations or problems that would prevent me from participating in any/all Yushinkan Dojo L.L.C. activities. Once again, I hereby assume all risks of personal injury, including death, resulting from participation.
     
    The parent or guardian of an applicant who is a minor hereby agrees to hold Yushinkan Dojo L.L.C., their members, agents, employees/instructors, successors and assigns harmless from any liability from physical injury, death or property damage resulting from classes/activities at Yushinkan Dojo L.L.C..  The parent or guardian fully comprehends and agrees that there are inherent risks involved with any physical activity, especially martial arts, and assumes all risks of personal injury, including death, resulting from the minor’s participation. The participant, and/or parent or guardian of the participant, further agrees to bind himself/herself, his/her heirs, administrators, and executors to repay and indemnify Yushinkan Dojo L.L.C. any sums of money that Yushinkan Dojo L.L.C., their members, agents, employees/instructors, successors and assigns may hereafter become liable to pay on behalf of the participant for any reason whatsoever.  

    Please type your full name in place of a signature.
    Please type your full name in place of a signature.

    For the safety of our students and staff members, we DO NOT offer visitation, trial classes, or services to anyone convicted of a criminal offense, felony, or CSC - criminal sexual conduct. 
    Agreement for possible criminal background check
Submit
Yushinkan Dojo LLC (The Aikido Center)
141 28th Street SE Suite #2
Grand Rapids, MI 49548
Call 616-929-0028
Last Updated 01/18/2020

  • About Us
    • The Dojo Tour
    • Study Group Heads
    • Student Registration
  • Classes
    • Daito Ryu Aiki Jujutsu Study Group
    • Aikido
    • Classical Japanese Sword & Staff
    • Shinkendo
  • Schedule
  • Events
  • Visit Us
  • Pay Online
    • Online Payment
    • Seminar Payment
  • Donate
  • Try a Free Class