Rock Water Aikikai Participant Information Form

Name: *

Participant Birth Date *

Year

Month

Day

Program(s) participant registering in: *

Child (Ages 6-9)

Youth (Ages 10-13)

Teen & Young Adult (Ages 14-25)

Sword and Staff: Adult and Teen (Ages 14-25)

Check all that apply

Guardian name and relationship to child:

If filling out for a child/youth participant. Leave blank if not.

Participant (or guardian) phone number: *

Participant (or guardian) email: *

Medical information Rock Water Aikikai staff should be aware of:

The participant contact information listed above will be given to Rock Water Aikikai for the purposes of communication between the program instructor, Sensei Martin Moreau, and participants and participant guardians. *

I understand

Rock Water Aikikai programs run on monthly billing system. Participants are billed on the 1st of each month. *

I understand

Participants that register during the program year do not begin classes until the month after they register. Ex. Participants that register online on June 7th would start classes in July. Registrants will not be billed until the month they start classes. *

I understand

This does not apply to you if you are registering before the program year begins (ex. Registering Dec 2022 for 2023 program year)

Cancellation/Refund Policy: 1 full calendar month notice required to withdraw from program. Therefore, new registrants are committing to 2 months of training. *

I understand

Ex. A participant withdrawing October 5th would be giving notice for the end of November, thus paying for the full November payment.

By ticking the box below, I hereby acknowledge that I have read and understand the course information section above. *

By ticking the box below, I hereby acknowledge that I am an adult (18+) filling this form out for myself, or that I am the legal guardian filling out this form for my child. I certify that the information given in this form is complete and true. *

I understand

Course Instructor Contact Information

Any program related questions can be sent to Sensei Martin Moreau at sensei@rockwateraikikai.com

I want to

Rock Water Aikikai Participant Information Form

Disclaimer