Otoshi Registration Form

Registration Form

Last Page

Parent / Guardian Information

Full Name: *

Email: *

We’ll use this email to send you all the details about this registration and updates from the Otoshi Team.

Phone: *

Address *

City *

Province *

Postal Code *

Emergency Contact Information

Emergency Contact Name *

Relationship with Participant *

Emergency Contact Phone *

Select Club Location (Dieppe or Riverview): *

Select Number of Kids

First Kid Registration

Select Class(Dieppe) *

1 class per week (Sat) - $ 50

2 Classes per week (Tue/Thu) - $80

2 classes per week (Mon/Fri) - $90

3 classes per week (Mon/Wed/Fri) - $115

3 classes per week (Mon/Wed/Fri) + conditioning $150

2 classes per week (Mon/Wed) - $90

4 classes per week (Tue/Thu/Fri/Sat) - $195

4 classes per week (Tue/Thu/Fri/Sat) + conditioning - $210

4 classes per week (Tue/Thu/Fri/Sat) + conditioning - $230

Select Class(Riverview) *

1 class per week (Fri) - $50

2 classes per week (Tue/Thu) - $80

2 classes per week (Mon/Fri) - $80

3 classes per week (Mon/Wed/Fri) - $90

2 classes per week (Mon/Fri) $90

3 classes per week (Mon/Wed/Fri) $135

2 classes per week (Tue/Thu) - $90

Name: *

Last Name: *

Date of Birth: *

Gender: *

Please indicate if there are any Illnesses / Allergies / Injuries:

Second Kid Registration

Select Class(Dieppe) *

1 class per week (Sat) - $ 50

2 Classes per week (Tue/Thu) - $80

2 classes per week (Mon/Fri) - $90

3 classes per week (Mon/Wed/Fri) - $115

3 classes per week (Mon/Wed/Fri) + conditioning $150

2 classes per week (Mon/Wed) - $90

4 classes per week (Tue/Thu/Fri/Sat) - $195

4 classes per week (Tue/Thu/Fri/Sat) + conditioning - $210

4 classes per week (Tue/Thu/Fri/Sat) + conditioning - $230

Select Class(Riverview) *

1 class per week (Fri) - $50

2 classes per week (Tue/Thu) - $80

2 classes per week (Mon/Fri) - $80

3 classes per week (Mon/Wed/Fri) - $90

2 classes per week (Mon/Fri) $90

3 classes per week (Mon/Wed/Fri) $135

2 classes per week (Tue/Thu) - $90

Name: *

Last Name: *

Date of Birth: *

Gender: *

Please indicate if there are any Illnesses / Allergies / Injuries:

Third Kid Registration

Select Class(Dieppe) *

1 class per week (Sat) - $ 50

2 Classes per week (Tue/Thu) - $80

2 classes per week (Mon/Fri) - $90

3 classes per week (Mon/Wed/Fri) - $115

3 classes per week (Mon/Wed/Fri) + conditioning $150

2 classes per week (Mon/Wed) - $90

4 classes per week (Tue/Thu/Fri/Sat) - $195

4 classes per week (Tue/Thu/Fri/Sat) + conditioning - $210

4 classes per week (Tue/Thu/Fri/Sat) + conditioning - $230

Select Class(Riverview) *

1 class per week (Fri) - $50

2 classes per week (Tue/Thu) - $80

2 classes per week (Mon/Fri) - $80

3 classes per week (Mon/Wed/Fri) - $90

2 classes per week (Mon/Fri) $90

3 classes per week (Mon/Wed/Fri) $135

2 classes per week (Tue/Thu) - $90

Name: *

Last Name: *

Date of Birth: *

Gender: *

Please indicate if there are any Illnesses / Allergies / Injuries:

Fourth Kid Registration

Select Class(Dieppe) *

1 class per week (Sat) - $ 50

2 Classes per week (Tue/Thu) - $80

2 classes per week (Mon/Fri) - $90

3 classes per week (Mon/Wed/Fri) - $115

3 classes per week (Mon/Wed/Fri) + conditioning $150

2 classes per week (Mon/Wed) - $90

4 classes per week (Tue/Thu/Fri/Sat) - $195

4 classes per week (Tue/Thu/Fri/Sat) + conditioning - $210

4 classes per week (Tue/Thu/Fri/Sat) + conditioning - $230

Select Class(Riverview) *

1 class per week (Fri) - $50

2 classes per week (Tue/Thu) - $80

2 classes per week (Mon/Fri) - $80

3 classes per week (Mon/Wed/Fri) - $90

2 classes per week (Mon/Fri) $90

3 classes per week (Mon/Wed/Fri) $135

2 classes per week (Tue/Thu) - $90

Name: *

Last Name: *

Date of Birth: *

Gender: *

Please indicate if there are any Illnesses / Allergies / Injuries:

Fifth Kid Registration

Select Class(Dieppe) *

1 class per week (Sat) - $ 50

2 Classes per week (Tue/Thu) - $80

2 classes per week (Mon/Fri) - $90

3 classes per week (Mon/Wed/Fri) - $115

3 classes per week (Mon/Wed/Fri) + conditioning $150

2 classes per week (Mon/Wed) - $90

4 classes per week (Tue/Thu/Fri/Sat) - $195

4 classes per week (Tue/Thu/Fri/Sat) + conditioning - $210

4 classes per week (Tue/Thu/Fri/Sat) + conditioning - $230

Select Class(Riverview) *

1 class per week (Fri) - $50

2 classes per week (Tue/Thu) - $80

2 classes per week (Mon/Fri) - $80

3 classes per week (Mon/Wed/Fri) - $90

2 classes per week (Mon/Fri) $90

3 classes per week (Mon/Wed/Fri) $135

2 classes per week (Tue/Thu) - $90

Name: *

Last Name: *

Date of Birth: *

Gender: *

Please indicate if there are any Illnesses / Allergies / Injuries:

Select Number of Adults

First Adult Registration Information

Adult Class – Dieppe *

2 classes per week (Mon/Wed) - $90

Adult Class – Riverview *

2 classes per week (Tue/Thu) - $90

Name: *

Last Name: *

Date of Birth: *

Gender: *

Please indicate if there are any Illnesses / Allergies / Injuries:

Second Adult Registration Information

Adult Class – Dieppe *

2 classes per week (Mon/Wed) - $90

Adult Class – Riverview *

2 classes per week (Tue/Thu) - $90

Name: *

Last Name: *

Date of Birth: *

Gender: *

Please indicate if there are any Illnesses / Allergies / Injuries:

Third Adult Registration Information

Adult Class – Dieppe *

2 classes per week (Mon/Wed) - $90

Adult Class – Riverview *

2 classes per week (Tue/Thu) - $90

Name: *

Last Name: *

Date of Birth: *

Gender: *

Please indicate if there are any Illnesses / Allergies / Injuries:

Fourth Adult Registration Information

Adult Class – Dieppe *

2 classes per week (Mon/Wed) - $90

Adult Class – Riverview *

2 classes per week (Tue/Thu) - $90

Name: *

Last Name: *

Date of Birth: *

Gender: *

Please indicate if there are any Illnesses / Allergies / Injuries:

Fifth Adult Registration Information

Adult Class – Dieppe *

2 classes per week (Mon/Wed) - $90

Adult Class – Riverview *

2 classes per week (Tue/Thu) - $90

Name: *

Last Name: *

Date of Birth: *

Gender: *

Please indicate if there are any Illnesses / Allergies / Injuries:

You must register at least one class to submit the form.

CAD

0.00

Gran Total + Square Fee(3% + 0.30)

CAD

0.00

Awareness and Assumption of Risk, Release of Liability, Waiver of Claims and Indemnity Agreement *

I have read and agree to the above

AWARENESS AND ASSUMPTION OF RISK
I am aware that Judo involves risks including risk of personal injury, death, property damage, expense and related loss, including loss of income. Included in these risks are negligence on the part of Judo NB, its directors, officers, staff, officials, member clubs, volunteers, Judo Canada, other participants and owners of the facilities where activities occur. I freely accept and fully assume all such risks and the possibility of personal injury, death, property damage, expense and related loss, including loss of income.
RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT
In consideration of Judo NB accepting my application to participate in Judo activities, I agree:
1. To waive any and all claims that may I have in the future against Judo NB, its directors, officers, staff, officials, member clubs, volunteers, Judo Canada, other participants and owners of the facilities where activities occur.
2. To release Judo NB, its directors, officers, staff, officials, member clubs, volunteers, Judo Canada, other participants and owners of the facilities where activities occur from any and all liability for any personal injury, death, property damage, expense and related loss, including loss of income that I or my next of kin may suffer as a result of my participation in this activity, due to any cause whatsoever, including negligence, breach of contract or breach of any statutory duty of care.
3. To hold harmless and indemnify Judo NB, its directors, officers, staff, officials, member clubs, volunteers, Judo Canada, other participants and owners of the facilities where activities occur from any and all liability for any damage to property of, or personal injury to, any third party, resulting from my participation in this activity.
4. To allow the use of my name, photographic image, and relevant personal information for the promotion of judo in the media, judo related publications & websites, and for use by governing judo associations, when deemed appropriate by Judo NB.

Club Otoshi Waiver *

I have read and agree to the above

I understand and agree that in participating in any Judo class, workshop, rehearsal or performance, there is a possibility of physical injury or death. I voluntarily agree, therefore, to assume all risks and responsibility for any such injury or accident, which might occur to me or my child during any of OTOSHI’s classes, rehearsals, performances, or activities. I also exempt, release, and indemnify OTOSHI, its owners, agents, volunteers, assistants, employees, faculty members, and/or students from any and all liability claims, demands, or causes of action whatsoever from any damage, loss, injury, or death to me, my children, or property which may arise out of or in connection with participation in any classes or activities conducted by OTOSHI. I further hereby voluntarily agree to waive my rights and that of my heirs and assigns to hold OTOSHI, its owners, agents, volunteers, assistants, employees, faculty members, and/or students liable for such damage, loss, injury, or death. I understand that I should be aware of my physical limitations and agree not to exceed them. If I am signing this waiver for my children, I certify that I am the parent or legal guardian and have the right to waive these rights. Permission is granted to OTOSHI to use photographs of members for publicity purposes. The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, provincial, and local governments and federal and provincial health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. OTOSHI has put in place preventative measures to reduce the spread of COVID-19; however, OTOSHI cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending OTOSHI could increase your risk and your child(ren)’s risk of contracting COVID-19. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending OTOSHI and that such exposure or infection may result in personal injury, illness, permanent disability or death. I understand that the risk of becoming exposed to or infected by COVID-19 at OTOSHI may result from the actions, omissions, or negligence of myself and others, including, but not limited to, OTOSHI employees, instructors, and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at OTOSHI Judo or participation in OTOSHI classes (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless OTOSHI, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of OTOSHI, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in OTOSHI.