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
*
Indicates required field
Name
*
First
Last
Date of Birth
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Email
*
Phone Number
*
Registering for which Class/Classes?
*
Emergency Contact
*
Please provide an emergency contact providing name, address, phone number, relation to self.
How did you hear about us?
*
Comment or question
*
RELEASE FROM LIABILITY FORM
Yushinkan Dojo L.L.C.
Please complete, sign, and date below.
I,
Full Name of participant (waiver)
*
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.
Participant Signature (Full Name) waiver:
*
Please type your full name in place of a signature.
Parent or Guardian (if participant is a minor) Signature (Full Name) waiver:
*
Please type your full name in place of a signature.
Date (of Waiver signing):
*
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.
Criminal Background Check Agreement
*
By checking this box, you are agreeing to a potential criminal history and CSC background check, and that Yushinkan Dojo LLC reserves the right to refuse service based on the result of this background check.
Agreement for possible criminal background check
Submit
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