Event Date: Saturday, January 28th, 2023 

Time12:30 - 2:30 pm

Cost: $20 per student. Open to Dojo students and children in the Holt Community.

Capacity: 50 Students

Location: St. Matthew Lutheran Church. 2418 Aurelius Rd. Holt MI

Join us for an afternoon of fun and great memories!


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Registrant Fee: $0.00

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Billing and Payment
Billing and payment processing for Businesses' events is performed by Member Solutions, Inc. ("MSI"), and this contract is specifically assigned to MSI for all such purposes. Customer knowingly and irrevocably authorizes MSI to charge electronically Customer's bank account and/or credit card for any and all amounts due for Customer's, and anyone registering under Customer's, attendance and participation in the Event. Please note, you may see all or any portion of the following on your bank or credit card statement: "MSI*HOLTDOJO 8882448044 ONLINE REG FEE". Any returned payment will be assessed a $25.00 fee. Any unsuccessful electronic transaction is subject to a $10.00 processing fee. MSI is not responsible for any bank fees incurred by Customer. MSI has the sole right to resubmit returned or declined items (plus applicable fees) without prior notice. BILLING INQUIRIES -- 888-244-8044 or by mail to PO Box 297, Hatboro, PA 19040.

Applicant Agreement
I represent that I am the person who appears on the application above. I acknowledge and agree to the statements, terms and conditions above, as well as any applicable terms and conditions for this registration, and that by typing my name below and completing this registration form, I am electronically signing the document, which will have the same legal effect as the execution of the document by a written signature and shall be valid evidence of my intent and agreement to be bound.

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Original Okinawan Karate of Holt
(517) 694-5001
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In consideration of being permitted to participate in any way in the Martial Arts Program indicated below and / or being permitted to enter for any purpose any restricted area (here in defined as any area where in admittance to the general public is prohibited), the participant or parent(s) and / or legal Guardians of the minor participant named below agree:

1. I will not hold Original Okinawan Karate of Holt, its employees or volunteers liable or responsible for any viral, germ, bacteria or infectious disease I may contract, including covid-19.
2. Prior to participating in the below martial arts activity or event, the student (adult or youth) should inspect the facilities and equipment to be used, and if he or she believes anything is unsafe, the participant should immediately advise the officials of such condition and refuse to participate. I understand and agree that, if at any time, I feel anything to be UNSAFE; I will immediately take all precautions to avoid the unsafe area and REFUSE TO PARTICIPATE further. If the student is a minor, the parent(s) and / or legal Guardians will instruct & assist the minor participant of the above listed procedure.
3. I / We fully understand and acknowledge that:
a. There are risks and dangers associated with participation in martial arts events and activities which could result in bodily injury
partially and / or total disability, paralysis and death.
b. The social and economic losses and / or damages, which could result from these risks and dangers described above, could be
c. These risks and dangers may be caused by the action, inaction or negligence of the participant or the action, inaction or
negligence of others, including, but not limited to, the Releasees named below.
d. There may be other risks not known to us or are not reasonably foreseeable at this time.
4. I / We accept and assume such risks and responsibility for the losses and / or damages following such injury, disability, paralysis or death, however caused and whether caused in whole or in part by the negligence of the Releasees named below.
5. I / We HEREBY RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE the martial arts facility used by the participant, including it’s owners, managers, promoters, lessees of premises used to conduct the martial arts event or program, premises and event inspectors, underwriters, consultants and others who give recommendations, directions or instructions to engage in risk evaluation or loss control activities regarding the martial arts facility or events held at such facility and each of them, their directors, officers, agents, employees, all for the purpose herein referred to as “Releasee”, from all liability to the undersigned, my / our personal representatives, assigns, executors, heirs and next of kin for any and all claims, demands, losses or damages and any claims or demands therefore on account of any injury of any nature, including but not limited to the death of the participant or damage to property, arising out of or relating to the event(s) caused or alleged to be caused in whole or in part by the negligence of the releases, or any other person on the premises.
6. I / We HEREBY acknowledge that THE ACTIVITIES OF THE EVENT(S) ARE VERY DANGEROUS and involve the risk of serious injury and / or death and / or property damage. Each of THE UNDERSIGNED also expressly acknowledges that INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE OPERATIONS OR PROCEDURES OF THE RELEASEES.
7. Each of the undersigned further expressly agrees that the foregoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as is permitted by the law of the Province or State in which the event is conducted and that if any portion is held invalid, it is agreed that the balance shall, not withstanding continue in full legal force and effect.
8. On behalf of the participant and individually, the undersigned parent(s) and / or legal guardians for the minor participant executes the Waiver and Release. If, despite the release, the participant makes a claim against any of the Releasees, the parent(s) and or legal guardian(s) will reimburse the Releasee for any money which they have paid to the participant, or on his behalf, and hold them harmless.

Media Recording Release
I do hereby grant unrestricted permission to Original Okinawan Karate of Holt to use the image of myself or my child in print, video, social, and digital media. I agree that these images may be used by Original Okinawan Karate of Holt for a variety of purposes, and that these images may be used without further notifying me. I do understand that the last name will not be used in conjunction with any video or digital images. Such use includes the display, distribution, publication, transmission, or otherwise use of photographs, images, and/or video taken of my child for use in materials that include, but may not be limited to, printed materials such as brochures and newsletters, videos, and digital images such as those on the Original Okinawan Karate of Holt Web site.

I have read both the Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement and Media Recording Release, fully understand it’s terms, understand that I have given up substantial rights by signing it, and have signed it freely and voluntarily without any inducement, assurance, or guarantee being made to me and intend my signature to be complete and unconditional release of all liability to the greatest extent allowed by law.
Check this box to indicate that you have read and agree to all of the above terms & conditions