2025 Saeki Dojo Summer Camp Registration Form

Participant Information

First name*

Last name*

Single choice*

Dojo Instructor

Student

Date of Birth*

Year

Month

Day

Email*

Phone*

Address*

City*

Postal Code*

Province/State*

Country*

Dojo name*

Ottawa JKA Canada Affiliate

Ottawa JKA Canada registration number (if applicable)

Current Rank *

Program

Please, select the appropriate program

Instructors Program

Adults Program

Youth Program

Exam

Please, fill in this section only if you will be grading at the camp.

Kyu Exam

Dan Exam

Qualification Exam

BBQ

I will be attending the BBQ

Please, select the number of people in your party

Waiver

I acknowledge participating at my own risk and waive liabilities of all claims against Ottawa JKA and all its participants for personal injury or property damage resulting from participation in the Saeki Dojo Summer Camp held at the Ottawa JKA, 475 Cambridge Street South, Ottawa ON, K1S 4H6 from July 17 to July 20, 2025. I authorize any medical treatment deemed necessary by Ottawa JKA.

Name of parent/legal guardian, if under 18

Signature*

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