Name * First Name Last Name Participant Age * Date of Birth MM DD YYYY Karate Program * BASIC - $125 - ONE CLASS PER WEEK STANDARD - $155 -TWO CLASSES PER WEEK PREMIUM - $175 - THREE CLASSES PER WEEK ELITE - $200 - UNLIMITED CLASSES Email * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Parent / Guardian Full Name First Name Last Name Parent / Guardian Phone Number (###) ### #### Emergency Contact * First Name Last Name Emergency Contact Phone Number * (###) ### #### Participant's Occupation Student Employed Self-Employed Stay-Home Do you have any medical conditions we should be aware of? * How did you hear about us? * Family Member Social Media (Facebook, Instagram, Tik Tok) Website Google Search REFUND POLICY * Full Refund: If a refund is requested at least one week before the start of the month, a full refund will be issued, minus a $25 administrative fee. Partial Refund (Medical Only): Refunds requested within seven days of the start of the month or after the month has begun will only be granted for medical reasons, with a doctor’s note required. The refund will be prorated based on the number of remaining classes, minus the $25 administrative fee. No Refunds for Missed Classes or Sick Days: Missed classes will not be refunded and make-up classes might be available at sensei’s discretion. Members are responsible for their attendance and commitment. I Agree CANCELLATION POLICY * A student’s enrolment may be terminated at the instructor’s discretion under the following conditions: 1. If a student requires one-on-one supervision and is deemed “not ready” for group training. 2. If a student has difficulty following instructions and staying engaged in class. 3. If a student frequently wanders off during instruction or activities. 4. If a student engages in inappropriate behavior, such as but not limited to: 5. Hitting, pushing, or causing harm to others. 6. Yelling, harassment, or showing disrespect to instructors/assistants. 6. If a student’s behavior is disruptive to the learning environment and negatively impacts other students. 7. If a parent/guardian repeatedly questions or challenges the instructor’s curriculum in a disruptive manner or shows disrespect toward the instructors or assistants. Students deemed “not ready” for participation may be invited to return at a later date, based on the instructor’s assessment (e.g., next session, or in six months). I Agree LEAVE OF ABSENCE POLICY * Attendance & Disciplinary Policy: • If a student is absent for three consecutive classes without prior notice, they may receive a warning notification and may be suspended from the dojo for one week without the opportunity to make up missed classes. • Repeated unexcused absences may result in expulsion from the dojo. • Late Arrivals: If a student arrives 15 minutes late without prior notice, they will not be allowed to join the class. • If a member is injured and unable to train, they are strongly encouraged to attend classes and observes what is taught; this avoids the need to apply for a leave of absence. Leave Of Absence & Withdrawal Policy: • Members must continue paying dues unless they formally withdraw or request a leave of absence. • The maximum allowable leave of absence is two months. o During this time, members must pay 50% of their monthly dues to maintain their membership. o Exceptions for medical leave may be granted on a case-by-case basis. • Students returning from an extended leave of absence may be subject to a reduction in rank based on skill retention and training consistency. Vacation Policy: We understand that students may need to take time off for travel or personal reasons. However, to ensure fairness and maintain dojo operations, the following policies apply: Short-Term Absence (Up to 2 Weeks in a Month): • If a student will miss one or two weeks in a given month, the full monthly fee still applies. • Missed classes cannot be refunded or rescheduled, as class spots remain reserved. One-Month Vacation • If a student takes a full month off, they may choose to: 1. Pause their membership and lose their reserved spot. Upon returning, they must re-register if space is available. 2. Hold their spot by paying a reduced fee of 50% of the monthly tuition. This ensures they can return without re-registering. Extended Vacation (More than One Month): • If a student takes more than one month off, their membership is considered on hold, and they must: 1. Pay a 50% hold fee for the first month of absence. 2. After one month, membership will be paused, and re-registration will be required upon return. • Returning students may be subject to skill assessment to determine their readiness for grading or class placement. Important Notes: • Vacation holds must be requested in advance—failure to notify the dojo will result in automatic withdrawal. • Students who stop attending without prior notice will need to re-register as new students upon return, subject to space availability. • Extended absences may impact grading eligibility, as consistent training is necessary for progression. I Agree MEDIA CONSENT * In accordance with the Alberta Freedom of Information and Protection of Privacy Act, the JKA Karate-Do EMPOW- LIL Academy is seeking your consent to collect, retain, use and disclose photographs, videos, images, and/or names of karateka and groups of karateka in a variety of publications and on the JKA Karate-Do EMPOW-LIL Academy social media, website, video channels such as Facebook and YouTube, for educational purposes, such as recognizing and encouraging student achievement, and for the purposes of building the Academy community and informing others about our program and activities. I Agree I Do Not Agree ACKNOWLEDGEMENT OF RISK AND RELEASE OF LIABILITY * For Participants Under the Age of Majority in the Province of Alberta in which The Athletic Activities are Provided by the JKA KARATE-DO EMPOW LIL ACADEMY WARNING: THIS AGREEMENT WILL AFFECT YOUR LEGAL RIGHTS. READ IT CAREFULLY! The Parent/Guardian Must Read and Understand this Waiver Prior to the Minor Participating in Athletic Activities The following waiver of all claims, release from all liability, assumption of all risks, and other terms of this agreement are entered into by me on behalf of the Minor Participant (the “Minor”) with and for the benefit of: JKA KARATE-DO EMPOW LIL ACADEMY, Lilia Boaghi and Alberta JKA Karate Association, coaches, instructors, directors, officers, employees, volunteers, business operators, agents and site property owners or occupiers, (the “Organizations”). Occupiers are defined in accordance with the definition of occupiers contained in the Occupiers Liability legislation applicable to the Province of Alberta in which the Athletic Activities are provided by the Organizations. 1. I am the Parent/Guardian of the Minor and I am executing this waiver on behalf of the Minor in my capacity as Parent/Guardian and with the intent that this waiver be binding on myself and the Minor for all legal purposes. (If it's not appealed to you put N/A) 2.“Martial Arts/Self-defense Activities“ includes but is not limited to contact and non-contact sports, fitness activities, personal training instruction and activities, use of facilities, and fitness programs and services provided to the participant by the Organizations. 3. I acknowledge, agree, and fully understand that the information contained in the Martial Arts/Self-defense Activities is offered for informational purposes only and no other purpose. JKA KARATE-DO EMPOW LIL ACADEMY, Lilia Boaghi, Alberta, and JKA Karate Association, coaches, instructors, directors, officers, employees, volunteers, business operators, agents and site property owners or occupiers, (the “Organizations”) do not endorse and make no representation, warranty, guarantee, or claim concerning the safety or effectiveness of any techniques taught to the participant. The Organizations expressly disclaim any and all liability relating to the practice or use of such technique in any situation or their legality in any jurisdiction. The Participant or the Parent/Guardian of the minor is advised to seek legal advice regarding the legality or consequences for the use of any techniques illustrated, taught and/or discussed in the Martial Arts/Self-defense Activities. 4. I am aware that there are inherent and significant risks (“Risks”) associated with the participation in Martial Arts/Self-defense Activities. I am aware that the Risks include but are not limited to the potential for serious personal injury caused by any event or any condition of the facility or equipment where Martial Arts/Self-defense Activities are provided by the Organizations, and health risks such as transient light-headedness, fainting, abnormal blood pressure, chest discomfort, muscle cramps or soreness, and nausea. I understand the risks are relative to my own or the Minor’s state of fitness and health (physical, mental and emotional), and to the awareness, care and skill with which the Minor/Adult conducts himself or herself while participating in Martial arts/Self-defense Activities. 5. I freely accept and fully assume all responsibility for all Risks and possibilities of personal injury, death, property damage or loss resulting from the Adult's / Minor’s participation in Martial Arts/Self-defense Activities. I understand that although the organizations have taken steps to reduce the Risks and increase safety or the Martial Arts/Self-defense Activities, it is not possible for the Organizations to make the Martial Arts/Self-defense Activities completely safe. I accept these risks and agree to the terms of this waiver. 6. I acknowledge (on behalf of the Minor the Minor’s obligation) to immediately inform the nearest coach, instructor, employee, and/or volunteer of the Organizations if I (or the Minor) feel any pain, discomfort, fatigue or any other symptoms I (or the Minor) may suffer during and immediately after my (or his or her) participation in Martial Arts/Self-defense Activities. The Organizations understand I (or the Minor) may stop participating at any time, and may be requested to stop by a coach, instructor, employee, and/or volunteer of the Organizations who observe any symptoms of distress or abnormal response. 7. In addition to consideration given to the Organizations for my (or the Minor’s) participation in Martial Arts/Self-defense Activities, I agree: (a)to waive all claims that I (or the Minor) have or may have in the future against the Organizations; (b)to release and forever discharge the Organizations from all liability for all personal injury, death, property damage or loss resulting from my (or the Minor’s) participation in Martial Arts/Self-defense Activities due to any cause, including but not limited to negligence on my behalf (or the Minor) (failure to use such care as a reasonably prudent and careful person would use under similar circumstances), breach of any duty imposed by law, breach of contract or mistake or error in judgment of the Organizations; and (c)to be liable for and to hold harmless and indemnify the Organizations from all actions, proceedings, claims, damages, costs demand including court costs and costs on a solicitor and own client basis, and liabilities of whatsoever nature or kind arising our of or in any way connected with my (or the Minor’s) participation in Martial Arts/Self-defense Activities. 8. I agree that this waiver and all terms contained within are governed exclusively by the laws of the Province of Alberta of Canada in which the Martial Arts/Self-defense Activities are provided to the Minor by the Organizations. I hereby irrevocably submit to the exclusive jurisdiction of the courts of that Province of Alberta. Any litigation to enforce this waiver must be instituted in the Province of Alberta in which the Martial Arts/Self-defense Activities are provided by the Organizations. I confirm that I have had sufficient time to read and understand each term in this waiver in its entirety, and have agreed to the terms freely and voluntarily. I understand that this waiver is binding on me (or as the Parent/Guardian and the Minor) and my Legal Representative. I accept the terms and conditions set out in this online form and approve to use my name entered above as my signature. I Agree