NAME 

ADDRESS 

CITY STATE ZIP

TELEPHONE OR

AGEEMAIL ADDRESS

STYLE RANK 

INSTRUCTOR INSTRUCTOR'S RANK

SCHOOL NAME 

SCHOOL ADDRESS SCHOOL PHONE

CITY STATE ZIP

Kata

Grappling

 Chanbara

Kumite (Sparring)

Weapons Kata

I have read, I understand, and I agree to abide by all the rules and regulations set forth for this tournament. I understand that there is a risk of personal injury involved in this tournament and with this knowledge I agree to take full responsibility for all of my actions, and I agree to indemnify, save and hold harmless The Isshinryu Karate-do Association, its staff, instructors or assistants, Bossier High School and any of its staff or components, and Kennedy's Karate USA from any and all losses or claims caused by accident or injury to me or to any third persons who may be competitors or affiliated with and of the previously named entities in any manner, in the event that myself or said third person is injured in any way during this event. Because of the physical demands of Martial Arts tournament competition, I understand that I must be in good physical condition to participate in this event, and hereby certify by signing below that I am in good physical condition and that I do not have a medical condition that may pose a risk to myself or to any other competitors during the course of this event.

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SIGNATURE OF COMPETITOR

SIGNATURE OF PARENT/GUARDIAN