Thanks for your interest in our Aikikids program at the Ottawa Aikikai Dojo!

Please provide the following information in the boxes below to register:

The information collected will be used for the membership profile and for the waiver. Please note that in the first few boxes, we need the following information:

First name:

Last name:

Date of birth:

Parent's Name (first, last):

E-mail:

Mobile:

Address:

City:

Province:

Emergency Contact Name:

Emergency Contact Phone Number: