DENTOKAN & AIKIJUJUTSU SEMINAR

TM

JOINTLY HOSTED BY CMAA & SENKAKUKAN

February 18th, 19th & 20th of 2011 At the Gedatsu recreation hall, 4016 Happy Lane, Sacramento Calif. 95627

With Shihan Hobbs Col (Ret) Roy Jerry Hobbs, World Dentokan President Highest Grade: Judan, Hanshi, & Kaiden Arts: Iaijutsu, Aiki-, Karate, Kobujutsu Website: http://www.dentokanhombu.com

Friday - Karate and Bunkai (6 pm – 8 pm) Saturday - Aikijujutsu (9:00 am – 4:00 pm) 1hr. break, lunch included Sunday - Aikijujutsu (9:00 am – 3:00 pm) 1hr. break, lunch included Sunday – Shizan-Testing(3:30pm to 4:30pm) testing fee $30.00 per student

The cost of this three day seminar is $100 for all three days if paid in advance by Dec. 30th or $150.00 at the door.

Accommodations Travelodge Sacramento / Rancho Cordova, $41 to $56 avg/nightly 9646 Micron Way Sacramento, CA 95827 - (916) 361-3131

For More Information Contact:

Bill Henderson, Shihan OR Miguel Jurna, Shihan [email protected] [email protected] (916)-765-6683 (530)-701-5131

Sensei Roy J. Hobbs - Seminar Registration Form

Seminar: February 18-20, 2011 – Dentokan Karate and Aikijujutsu Seminar

PARTICIPANTS INFORMATION:

Name:______Male Female Age: _____ Birth date: ______(circle one)

Address:______

City:______State: ______Zip:______

Home Phone:______Work Phone:______E-mail:______

Emergency Contact: ______Relationship: ______Emergency Phone:______

School/Dojo and location: ______

Instructor: ______

Martial Art Styles and Ranks: ______

MEDICAL INFORMATION AND HISTORY:

MY MEDICAL INSURANCE CARRIER IS: ______

POLICY NAME/NUMBER: ______

1. Are you taking any prescription medication?______If yes, what kind and for what condition? 2. Do you have any physical limitations/injuries of concern?: ______

3. What illnesses or injuries have you received treatment for?: ______

I CERTIFY THAT THE ABOVE IS ACCURATE TO THE BEST OF MY KNOWLEDGE:

______(Your Signature or Signature of your Parent/Guardian if you are under 18) (Date)

______(Name of Parent/Guardian if you are under 18) Page 1 of 2

WAIVER:

I, the undersigned, acknowledge that I will be participating in a martial art involving strenuous exercise and personal body contact. I further certify that I am in proper health and physical condition to participate in such activities. As a seminar participant, I understand that the martial art activities may involve a risk or accidental injuries and I hereby voluntarily assume such risk and do hereby hold all organizations and individuals running or teaching the seminar (Sensei Hobbs Karate and Aikijujutsu Seminar and its Instructors), and their agents harmless from any and all liability (including attorney’s fees and costs) for all claims, actions or damages due to injuries suffered by me, arising out of activities involving . I hereby acknowledge the provisions of the California Civil Code Section 1542.

1. Agree that, prior to participating; I will inspect the mats, equipment, and facilities. Should I believe that anything is unsafe or beyond my capability I will immediately advise the instructor and/or official of the seminar and refuse to participate. 2. Acknowledge and fully understand that I will be engaging in a that might result in serious injury, including, but not limited to, injury, permanent disability or death, severe social and economic losses due not only to my own actions, inactions, or negligence, but also to the actions, inactions or negligence of others, or the conditions of the premises or of any of equipment used. Furthermore I acknowledge that there may be other risks not known to me or not reasonably foreseeable at this time. 3. Knowing the risks involved in this seminar I assume all such risks and accept personal responsibility for the damages following such injury, permanent disability, or death.

I hereby authorize any emergency medical treatment necessary in the event of accident or injury, while releasing the above mentioned organizations and individuals from any legal, financial, or other liability.

I hereby agree to total and complete authorization by Sensei Hobbs Dentokan Karate and Aikijujutsu Seminar, and/or its agents, to use all videotapes, photographs, negatives, proofs and/or slides taken of me for promotional purposes, display, publication, or for any lawful purpose whatsoever and that all videotapes, negatives and/or slides shall completely and irrevocably remain the property of Sensei Hobbs Dentokan Karate and Aikijujutsu, and/or its agents.

I, the undersigned, have read the above warnings, waiver, and release, and for myself, my heir's, executors, and administrators, waive my substantial rights and release the above mentioned organizations and individuals, their agents, representatives for all injuries. I agree to participate knowing the risks and conditions involved and do so entirely of my own free will. I affirm that I am at least 18 years of age or if I am under 18 years of age, I have obtained the required consent of my parents/guardians as evidence of their signature below. In addition, I acknowledge that I have received a copy of this waiver.

Participant Signature: ______Date: ______

For parents/guardians of the participants of minority age This is to clarify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release, as provided above, of all the releases for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the releases from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above, even if arising from their negligence to the fullest extent permitted by law. I have instructed the minor participant as to the above warnings and conditions and their ramifications.

Parent/Guardian Signature: ______Date: ______

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