Fighters for Black Belt Test

Osu! Chief Instructor of a World Kanreikai Karate school,

Please submit the list of your students/members – Green Belt and above, 16 years and over – who wish to take part as fighters in the upcoming Black Tip/ Black Belt Promotion Test.

This test will take place on Saturday, August 3, 2024, at 11h00 at Vaudreuil Kanreikai Karate dojo, located at 585, avenue Saint-Charles, Suite 280, Vaudreuil-Dorion, QC, J7V 8P9.

Each registered fighter will need to sign a release of liabilities on site, on the day of the test. In the case of fighters aged less than 18, a parent/guardian will need to sign the document to ensure their participation.

Please fill out and submit the form below as soon as possible:

1 form for up to 5 fighters.
If necessary, submit more than one form.

Thank you for your cooperation!

"*" indicates required fields

Ce formulaire doit être complété par le Shihan ou Sensei d'un dojo Kanreikai Karate. Un maximum de cinq (5) combattants inscrits par formulaire.
This form must be completed by the Shihan or Sensei of a Kanreikai Karate dojo. Up to five (5) fighters registered per form.

Votre nom et votre dojo Kanreikai / Your name and Kanreikai dojo*

Votre adresse courriel / Your Email Address*

Un message de confirmation sera envoyé à cette adresse
A confirmation message will be sent to this address

Nombre de combattants de votre dojo à inscrire (Max=5) / Number of fighters from your dojo to register (Max=5)*

Please enter a number from 1 to 5.

Y compris vous-même, si vous désirez participer au test comme combattant(e).
Including yourself if you wish to participate in the test as a fighter.

Combattant/ Fighter # 1 - Prénom et nom / First name and Last name*

Combattant/ Fighter # 1 - Âge / Age*