Nepalese Shito-Ryu Karate Academy of Canada (NSAC)
(Affiliated with Karate Ontario)
Development, Discipline, Dynamism
Training Registration Form
Last Name: ___________________________First Name:________________________________
Address: _____________________________City: ____________________Province:__________
Postal Code: _____________ Date of Birth: DD_____ MM_____YY_______ Gender: M F
Phone#:____________________________ E-mail: ____________________________________
Emergency Contact Person:___________________________Relationship:__________________
Telephone #_________________________ Mobile #:__________________________________
1. Insurance of any accidental during the training or participating tournament session is
automatically covering with the admission fees of the Karate Ontario.
2. Every year there will be renewal charge for the Karate Ontario per their regulation.
3. Each & Every grading upgrade will be charge separately.
4. Registration with the academy will charge one time only apart from monthly training
Name of the Guardian: ______________________
Signature of the Guardian: _______________________ Date: ___________________________
Signature of the Witness: _________________________ Date:___________________________
Approved by the Instructor: _______________________ Date:___________________________
Note: This training is launched with the kind cooperation of Canadain Newa Guthi.