Returning Black Belt Registratio...

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FIRST NAME

LAST NAME

E-MAIL

SELECT ONE OPTION: *

OPTION 1: YES. I will be attending the fall 2026 session.

OPTION 2: NO. I will not be attending the fall 2026 session nor any future sessions. Please let us know below why you are not returning.

OPTION 3: NO BUT. I will not be attending the fall 2026 session BUT include my name on the Black Belt list for the winter/spring 2027 session.

OPTION 4: OTHER. Please provide details below. We will contact you to discuss.

DID YOU CHANGE ADDRESS, PHONE NUMBER, E-MAIL, MEDICAL CONDITIONS/ALLERGIES OR EMERGENCY CONTACTS SINCE THE LAST SESSION? *

NO.

YES. Please provide the changes below.

WHICH DAYS/CLASSES ARE YOU AVAILABLE TO TEACH? *

TUESDAY & THURSDAY - both classes.

TUESDAY & THURSDAY - youths/adults class only.

TUESDAY & THURSDAY - children's class only.

TUESDAY only - both classes.

THURSDAY only - both classes.

Other.

WILL YOU BE AWAY DURING PART OF THE SESSION? *

NO.

YES. Please provide the dates below.

DO YOU NEED A NEW UNIFORM (DOGI)? *

NO.

YES.

FIRST NAME

LAST NAME

DATE OF SUBMISSION * required

Thanks for your submission. You will receive a confirmation e-mail shortly.

Tel: (250) 833-2911 or (250) 517-9917

Address: 2316 Lakeview Drive, Sorrento, BC, V0E 2W2

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