Deep South
Martial Arts Championships
Registration Form
(Type your information in the boxes below, print
this form out and bring it with you to the tournament.)
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NAME |
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ADDRESS |
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CITY STATE ZIP |
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TELEPHONE OR |
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AGEEMAIL ADDRESS |
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STYLE RANK |
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INSTRUCTOR INSTRUCTOR'S RANK |
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SCHOOL NAME |
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SCHOOL ADDRESS SCHOOL PHONE |
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CITY STATE ZIP |
Please check the events you will be competing in:
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Kata |
Grappling |
Chanbara |
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Kumite (Sparring) |
Weapons Kata |
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Regulation Martial Arts Uniform, Hand and Foot Pads, Headgear,
Mouthpiece, and
Groin Protector for males required in all divisions.
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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. |
If under 18 years of age, this release and consent must be also be signed by a parent or guardian.
___________________
Date
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____________________________________ |
____________________________________ |
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SIGNATURE OF COMPETITOR |
SIGNATURE OF PARENT/GUARDIAN |