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Family Registration



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Students Information

Special medical Concerns/Dietary Concerns/Other Notes

Participant Risk Waiver*

I understand that as in all sports/activities, there is a risk of physical injury and damage to property.  I hereby give my consent for my child/or myself printed above to receive emergency medical care which may become necessary in the course of such activities.  I further agree not to hold the Midori Ishi Kai Martial Arts staff or anyone acting on its behalf, responsible for any injury occurring to the names participant during the activities. Upon registration of my child/myself in the program, I permit my child/myself to participate in a full range of activities, and further authorize the staff and their appointee in the event of an accident or illness affecting the above named participant; to authorize on my behalf all procedures, including admission to hospital and necessary treatment therin, as he/she may deem essential for the care and well-being of the participant. Such action shall be taken only when immediate contact with the undersigned cannot be made.      

Photo and Release Consent*

Midori Ishi Kai Martial Arts requests to use, copy, or display child’s/myself name, photograph, or video recorded image to promote events& advertisements on websites, news releases, brochures, pamphlets or other.

18+ Criminal Records Check

Each Prospective Participant, over the age of eighteen (18) shall be subject to a criminal background check in accordance with the laws of Ontario and as they are amended from time to time. Due to the fact that Prospective Participants who are age 18 and over will be in contact with minors, the Club has an interest in ensuring the safety of the minors. Accordingly, all classes of Participants who are over the age of 18 shall be subject to a criminal background check in accordance with the laws of Ontario. Please check Yes if you are willing to provide a up to date criminal records check.


The Dojo Kun is a verbal affirmation. The purpose of the Dojo Kun is to remind all of the students in the dojo, regardless of their rank, that the physical, mental, and spiritual growth that they enjoy as a by product of their karate training, must also extend beyond the dojo's walls. By that I mean, in order to derive the true benefits of Shotokan karate-do, each student must take the underlying principles of this art form and make them a regular part of their daily life. SEEK PERFECTION OF CHARACTER-BE FAITHFUL-ENDEAVOUR-RESPECT OTHERS- REFRAIN FROM VIOLENT BEHAVIOUR And when you leave your dojo, always be sure and take the meaning of those words out into the world with you. Because it is in the every day world that is outside of those four walls that you train behind each day, that the true meaning of the dojo kun is truly meant to be practiced. As a student I will follow the DOJO KUN in and out of the club at all times, I understand that at any time I may be revoked from the club because of my actions.

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