IKD Canada Cup Registration

Page 1

Fields

First Name
Last Name
Dojo
Province
Email
Date of Birth (DD/MM/YYYY)
Age as of Oct 17, 2025
Gender	Gender Male Female
Rank
Age Group
Rank Group
Special Needs Division	Yes No
Event: Individual Kata	Yes No
Event: Individual Kumite	Yes No
Event: Team Kata	Yes No
Event: Team Bunkai (Brown & Black Belts Only)	Yes No
Event: Team Enbu (Brown & Black Belts Only)	Yes No
Event: Team Kumite (Brown & Black Belts Age 18-59 Only)	Yes No
Release Agreement	Yes No I have read and agree to the terms and conditions of the following TWO Release Waivers: Release Waiver AND Image/Video Release Waiver.
Parent of Minor Competitor?	Yes No
Parent's Name
Minor Release Agreement	Yes No I am the parent or legal guardian of this minor. I have read and agree to the terms of the following TWO Release Waivers on their behalf. Release Waiver AND Image/Video Release Waiver.