Shito-Ryu USA Karate Do Kai - the Pacific Karate-Do Institute

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Page 1. Shito-Ryu USA Karate Do Kai. MEMBERSHIP and RENEWAL FORM. MEMBER # M-______. YEAR : 2013. NAME: AGE: ______ D.O.B. ...
Shito-Ryu USA Karate Do Kai MEMBERSHIP and RENEWAL FORM YEAR : 2017

MEMBER # M-_____________

NAME: ___________________________________ AGE: _____________ D.O.B. _______________ ADDRESS: ________________________________ CITY: __________________________________ STATE: ________________________________

ZIP: ___________________________________

PHONE: ___________________________ Email: __________________________________________ CURRENT RANK: __________________

DATE of ENROLLMENT: ____________________

(Return this form to: John Bartholomay)

STATEMENT PACIFIC KARATE-DO INSTITUTE / Santa Barbara, California USA Bartholomay Dojo Nippon Karate-Do Kai is headquartered in Osaka, Japan and is the honbu (home dojo) of Kenzo Mabuni Soke. Shito-Ryu USA Karate Do Kai is our organization of karate dojos in the United States, PKI is one of the dojos that represent this organization. Kenzo Mabuni Soke is the head of Shito-Ryu USA Karate Do Kai, which is the American organization that is part of the International Karate-Do Kai. The International Karate-Do Kai represents all the Seito Shito Ryu dojos from each country around the world. All PKI dan ranks (black belts) are registered in Japan, and all kyu ranks (color belts) are registered with Shito-Ryu USA Karate Do Kai. This offers students a legitimate rank worldwide. PLEASE READ AND SIGN THE FOLLOWING: * I will train faithfully to strengthen my mind and body. * I am willing to endure rigorous training to achieve my goal. * As my strength increases I shall seek to cultivate a gentle heart. * I will not use my skill outside the Dojo, except in the most extreme circumstances. * At all times I will try to avoid inflicting injury upon another person. * I will not brag about my skill nor will I use it maliciously. * I will train with the spirit of humility.

I will not hold my instructors or the Pacific Karate-Do Institute liable for any injury which may Occur during my training.

(Signature)

(Parent’s or guardian’s signature if under 18)

(Date)

(Date)