5 th Annual Grassroots Judo Junior, Youth, Team, & Kata National Championships

Size: px
Start display at page:

Download "5 th Annual Grassroots Judo Junior, Youth, Team, & Kata National Championships"

Transcription

1 5 th Annual Grassroots Judo Junior, Youth, Team, & Kata National Championships CHAMPIONSHIP ENTRY PACKET Neal S. Blaisdell Center, Honolulu, HI July 3 5, 2014 USJF Sanction # The Judo Events will consist of Junior Shiai, Junior Kata and Yudanshakai Team competition. This tournament is open to all players who possess a valid USJF, USJA, USA Judo membership card with current insurance or Foreign (proof of NGB membership required). Sponsored and Hosted by: Tournament Headquarters: Optional Hotel: ( one block away) Deadline for rates: 5/26/2014 Competition Site: Referee Meeting: Competition Dates for Championships: Tournament Coordinator: Head Shiai Referee: Head Kata Judge: 50 th State Judo Association Ohana Waikiki East Hotel 150 Kaiulani Avenue Honolulu, HI (standard rooms) Ohana Waikiki Malia Hotel 2211 Kuhio Avenue (connecting rooms/kitchenettes) $159+tax/night and up (Event Rate) Use key https://aws.passkey.com/g/ Neal S. Blaisdell Arena 777 Ward Avenue Honolulu, Hawaii Thursday July 3, Ohana Waikiki East Hotel Friday 7/4/2014 Bantam, Intermediate & Juvenile B Saturday 7/5/2014 Juvenile A, IJF Junior, IJF Junior Open, Kata, & Team Ray Imada, Joon Chi Eiko Shepherd Page 1 of 18

2 Thursday, July 3, 2014 SCHEDULE OF EVENTS 9 am to 5 pm Registration (All Competitors) Hawaii Suites - 9 am to 5:30 pm Weigh In (All Competitors) Neal S. Blaisdell 9 am to 5 pm Coaches Registration/ Check-In Note: No coaches badges will be issued on the days of competition Center Complex 9 am to 3 pm Referee Registration/ Check-In 1 pm-5 pm (tentative) Referee Meeting Ohana Waikiki East 8:30 pm (Tentative) Coaches Meeting Hotel Conference Room 10 pm (Approximate) Draw Sheets posted Friday, July 4, am Doors open to Public - Texas Match Cards available for Friday competition 8 am Referee/Coaches Meeting 7:30 am to 8:15 am Mat open for warm-ups 8:15 am Competitors and Officials assemble for Opening ceremonies on Floor 8:30 am Opening Ceremonies 9 am Competition begins for Bantam, Intermediate and Juvenile B Neal S. Blaisdell Arena Saturday, July 5, :30 am Doors open to Public - Texas Match Cards available for Saturday competition 8 am Referee/ Coaches meeting 8 am to 9 am Mat open for Warm-ups 9 am Competition begins for Kata Juvenile A, IJF Junior, IJF Junior Open, & Yudanshakai Team competitions follow the conclusion of the Kata Competition Neal S. Blaisdell Arena Page 2 of 18

3 INDIVIDUAL COMPETITION (Eligibility Requirements): Individual Competition is open to any male or female born from 1994 to 2006 inclusively, with the following restrictions: 1. ALL CONTESTANTS must be a current member of at least one of the following organizations and have current insurance coverage with that organization on the day of competition: United States Judo Federation, United States Judo Association, USA Judo or Foreign Competitors National Judo Passbook. Copy of passport or government issued birth certificate required. Copy of USJF, USJA or USA Judo Card. 2. NO AGE WAIVERS will be CONSIDERED or ACCEPTED. Except for Juvenile B wishing to compete in IJF Junior (See Consent of Weight / Age Consent Form) 3. If the contestant holds a recognized rank of Shodan (1 st Degree Black Belt) or higher, from USJF, USJA OR USA Judo or Recognized National Federation, you must have copy of rank certificate or copy of current USA Judo membership card having the rank verification symbol V printed following the rank. 4. If the contestant s rank is lower than Shodan, the Certificate regarding Non-Black belt contestants must be completed and signed by a coach who holds a recognized Black Belt rank (Copy of Coach s Black Belt Rank) is required. KATA COMPETITION: (Eligibility Requirements): 1. Any combination of male, female or mixed pairs who meet the requirements specified under the individual competition eligibility requirements. 2. Kata Teams may have US and International team members. TEAM CHAMPIONSHIPS: (Eligibility Requirements): 1. Only registered Yudanshakais and Associate Yudanshakais, in good standing with the USJF, are permitted to enter teams in the Yudanshakai team competition. 2. All competitors must be members in good standing with their Yudanshakai and the USJF, and registered with the National Office by 31 March of the year of competition. 3. All team competitors may only represent the Yudanshakai where each competitor is a member. Page 3 of 18

4 REGISTRATION, ENTRY FEES EARLY REGISTRATION: The official entry form and all other forms and documents must be fully completed, properly signed, appropriate fees enclosed, money ordered or check (NO CASH), mailed to the address stated below and postmarked no later than May 18, POSTMARKED BY MAY 18, 2014 Shiai --- Individual Entry Fee $ Kata Team --- One Kata $ Kata Team --- Two Katas $ Kata Team --- Three Katas $ LATE REGISTRATION: The official entry form and all other forms and documents must be fully completed, properly signed, appropriate fees enclosed, money order or check (NO CASH), mailed to the address stated below and postmarked no later than June 18, POSTMARKED BY JUNE 18, 2014 Shiai --- Individual Entry Fee $ Kata Team --- One Kata $ Kata Team --- Two Katas $ Kata Team --- Three Katas $ DO NOT MAIL ANY ENTRY FORMS AFTER 6/18/2014! Any entry form received with a late postmark is VOID. Competitor will need to bring the entire entry packet to registration and pay the walk-in fees listed below. WALK-UP REGISTRATION: Thursday, July 3, 2014 at Hawaii Suites at the Neal S. Blaisdell Center. NO PERSONAL CHECKS. Cash, money order or cashier s check only. Shiai ---Individual Fees $ Kata Team --- One Kata $ Kata Team --- Two Katas $ Kata Team --- Three Katas $ INCOMPLETE ENTRY APPLICATIONS: Entries with incomplete or missing information will be charged the walk-up registration fees. NO FRIDAY/SATURDAY REGISTRATION or WEIGH-INS ENTRY FEES ARE NON-REFUNDABLE Make Checks payable to: 50 th State Judo Association Mail to: c/o Ray Imada Malukai Place, Kaneohe, HI Page 4 of 18

5 INDIVIDUAL COMPETITION INDIVIDUAL COMPETITION RULES: The Championships will be conducted in accordance with the Contest Rules, Organization Code and the Sporting Code of the International Judo Federation, as revised for the 2014 USJF Junior Judo Championships as follows: Shime-waza (chokes) is allowed in Juvenile A, B, IJF Junior, and IJF Junior Open Divisions ONLY. Kansetsu-waza (arm-locks) is allowed in JUVENILE B, IJF Junior, and IJF Junior Open Divisions ONLY. Match Lengths: Bantam, Intermediate, Juvenile A 3 minutes Match Lengths: Juvenile B and IJF Junior 4 minutes Injury Rule: Decisions as to whether an athlete may continue if injured while on the mat are to be resolved in accordance with IJF rules. Such decisions occurring off the mat or not covered by the IJF rules are to be made by the coach, the athlete, and the team doctor. If there is not a unanimous opinion among these three individuals, the athlete MAY NOT continue. Judo Gi Sizing: Athletes competing in Juvenile B, IJF Junior, & IJF Junior Open categories MUST wear judogis that comply with the 2014 IJF judogi specification regarding sizing. Judo Gi Sizing: Athletes competing in Bantam, Intermediate, and Juvenile A categories MUST wear judogis that comply with the 2013 or 2014 IJF judogi specification regarding sizing. Judo Gi Color: The wearing of a Blue Judo gi by the blue side competitor will be required. Competitors are responsible for appearing in the correct color gi. Under no circumstance shall both competitors be allowed to compete in blue or white gis, nor will the blue and white competitors be allowed to switch positions. Each athlete must appear with the appropriate color judogi. The gi jacket and pants must be the same color; no mixing of colors. A competitor may compete in one division ONLY according to their year of birth and official weight, with the following exceptions: o For Bantam and Intermediate divisions ONLY. If the contestant s division is uncontested, the player may move up one weight category where there are matches if consent for weight division change has been given by parent/legal guardian (See Consent for Competition Bracket Change Form). Any changes must be made prior to the start of the draw. o Juvenile B contestants may compete in the IJF Junior category instead of, or in addition to, the Juvenile B category. Those who choose to compete in both categories must fill out TWO (2) entry forms and pay TWO (2) fees. The above listed exceptions MAY ONLY be applied with the written consent of the parents/legal guardians of the contestants under the age of 18 years old. Refer to the Consent for Competition Bracket Change Form. The 2014 Tournament Committee has the authority to make any changes appropriate for the betterment of the tournament. METHOD OF COMPETITION These Championships will be using the Modified Double Elimination System. 1 st, 2 nd and 3 rd place will be awarded medals. The Championship bracket winner will be 1 st, with no losses. The loser of the Championship match will face the winner of the Consolation bracket, for 2 nd and 3 rd place, even if they had competed with each other in earlier rounds. Divisions with only three contestants will be run as round-robin. Divisions with only two contestants will be best 2 of 3. Page 5 of 18

6 AWARDS Awards will be given for First, Second and Third Place in the individual and Kata Competition. All award recipients MUST be wearing a judo gi when receiving their awards. SEEDING OF ATHLETES, DRAW PROCEDURES AND SCHEDULING There will be NO seeding of athletes. The draw will be random, with the restriction that players having the same State affiliation will be placed as far apart in the bracket as possible. The TEXAS MATCH CARD system will be used. Contestants will receive a card specifying their contest area number (mat #) and match number. All contestants are expected to report to their assigned contest area 3 matches prior to their assigned match number; failure to report at the designated time may result in the competitor forfeiting that match. INDIVIDUAL COMPETITION CATEGORIES AND WEIGHT DIVISIONS Please note that each category is based solely on the year in which the contestant was born. The contestant s actual age on the day of competition is irrelevant. All weight listed below are in kilograms. For each weight division, the weight range will be over the next lower weight and up to and including the weight listed. Example: Bantam 27 kg : over 23 kg and up to and including 27 kg. The Tournament Committee reserves the right to modify the divisions to make them more competitive. The following Age/Weight Categories will be used for the competition: Category Year Born Male Divisions Female Divisions Bantam , 27, 31, 35, , 27, 31, 35, +35 Intermediate , 30, 34, 38, 43, , 30, 34, 38, 43, +43 Intermediate , 31, 34, 38, 42, 47, 52, , 31, 34, 42, 47, 52, +52 Juvenile A , 40, 44, 48, 53, 58, 64, , 40, 44, 48, 53, 58, 64, +64 Juvenile B , 55, 60, 66, 73, 81, 90, , 44, 48, 52, 57, 63, 70, +70 IJF Junior (U.S.A , 60, 66, 73, 81, 90, 100, , 48, 52, 57, 63, 70, 78, +78 citizenship only) IJF Junior Open (Any country) , 60, 66, 73, 81, 90, 100, , 48, 52, 57, 63, 70, 78, +78 Page 6 of 18

7 KATA COMPETITION Nage No Kata Junior Division: (Born ) First Three Sets of Nage No Kata (Te-waza, Koshi-waza and Ashi-waza) Youth Division: (Born ) Full Set of Nage No Kata Katame No Kata Junior Division: (Born ) First Two Sets of Katame No Kata (Katame-waza, Shime-waza) Youth Division: (Born ) Full Set of Katame No Kata Ju No Kata Junior Division: (Born ) First Two Sets of Ju No Kata (Ikkyo, Nikyo) Youth Division (Born ) Full Set of Ju No Kata ELIGIBILITY All junior registered USJF, USJA, USA Judo and International Players in good standing are eligible to compete in the Kata Portion of this National Competition. All team members must meet all other eligibility requirements and restrictions as governed by the 5 th Annual Grassroots Judo Junior, Youth, Team & Kata National Championships. KATA COMPETITION VENUE AND TIME Competition will take place on Saturday, July 5, 2014 (see Schedule of Events) at the Neal S. Blaisdell Arena KATA ENTRY INFORMATION Team must submit the proper entry fees and application for EACH KATA category. See registration and Entry Fees for deadline dates for appropriate fees. The actual team member s name must be stated on the application form and sent in as ONE application. Kata applications sent in separately will be returned as incomplete. Each team member must have all properly completed waivers, Consent and Liability, Proof of Age Requirements and all other documents require for this competition. Note: Check-Off List must be completed and submitted (if missing, it will be considered INCOMPLETE). All Kata Teams must register during the Tournament Registration times (See Schedule of Events) Page 7 of 18

8 TEAM CHAMPIONSHIPS COMPOSITION 1. Yudanshakai teams shall consist of a maximum of five members meeting the following age citeria: a) Male Team: i) Intermediate 1, under heavyweight -43 kg ii) Intermediate 2, under heavyweight -52 kg iii) Juvenile A, under heavyweight -64 kg iv) Juvenile B, under heavyweight -90 kg v) IJF Junior, no weight limitation b) Female Team: i) Intermediate 1, under heavyweight -43 kg ii) Intermediate 2, under heavyweight -52 kg iii) Juvenile A, under heabyweight -64 kg iv) Juvenile B, under heavyweight -70 kg v) IJF Junior, no weight limitation 2. Competitors may compete only once in each team match. 3. The competitors may be of any rank, providing they meet the age and weight limitations. The USJF recommends that the minimum age for each position be no less than one year under the age minimum and age 15 for the IJF Junior position. Coaches and parents are urged to exercise great caution given differences of physical and mental maturity between junior and youth aged athletes. 4. Team competitors need not register as a team before the tournament. Instead the team captain or the Yudanshakai s coach shall submit the team roster to the Head Scorekeeper, one hour prior to the start of the team tournament. 5. The weight of the competitors as recorded for individual competition will serve as their weight for team competition. If a team member did not compete in the individual competition, then that competitor must be weighed at time of submission of the team rosters. 6. Both male and female teams are contested in a modified double elimination system. The team pool charts to be used are the same charts used in individual competition. TOURNAMENT PROCEDURES 1. The head scorer shall call teams, by microphone, to report to assigned mat areas. 2. The mat recorder should ascertain that all competitors have reported. 3. The rules governing the individual matches in the team competition will be the same as the rules governing that age group in individual competition. 4. All matches will be 3 minutes long with no Golden Score overtime. 5. The team shall report in the appropriate color judogi. 6. If a competitor drops out and if the team does not field a member in a position, the loss will be recorded as an ippon for other team. 7. Points will be assigned in the following manner: Win by i) Ippon - 5 points ii) Wazaari - 4 points iii) Yuko - 3 points iv) Shido - 1 point v) Loss - 0 points vi) If two competitors of any match are tied at the end of the match, a decision of hikiwake shall be rendered. 8. Determination of winners: i) The total number of wins and points will be tabulated after all five matches. ii) The team winner shall be the team with most wins. If tied, team with most points will be declared winner. Page 8 of 18

9 TOURNAMENT CHECK-IN & WEIGH-IN TOURNAMENT CHECK-IN (ALL COMPETITORS): All contestants (Shiai and Kata) must check-in to register and weigh- in, in person, at the Hawaii Suites at Neal S. Blaisdell Center, 777 Ward Avenue, Honolulu, HI 96814, on Thursday, 7/3/2014, from 9 am to 5 pm. During Tournament Check-in, all late and incomplete registrations will be required to properly complete all forms and pay appropriate fees. NO EXCEPTIONS. TOURNAMENT CHECK-IN (COACHES AND REFEREES): All Coaches MUST register on Thursday, 7/3/2014, from 9 am to 5 pm, in person, at the Hawaii Suites at Neal S. Blaisdell Center. During Check-in, coaches will be required to properly complete late and incomplete forms and pay appropriate fees and show proof of current membership in USJF, USJA, or USA Judo. All referees are to check in on Thursday, 7/3/2014 from 9 am to 4 pm, in person, at the Hawaii Suites Blaisdell Center and show proof of current membership in USJF, USJA, or USA Judo. WEIGH-IN (ALL COMPETITORS); Practice scales will be available to all competitors to check their weights, as many times as desired prior and up to 4:30 pm on day of registration. Contestants will only be allowed one chance on the scales at the official weigh-in. COACHES CREDENTIALS: Coach s badges will be provided to National Certified Coaches ONLY (USJF, USJA or USA Judo). In order to expedite the registration process, coaches must send Coaches Badge Application Forms to the address printed on the form. Coaches who register as Walk-Up will be charged $50 and must present all required forms and documents. No coaches will be allowed at mat side without the Official Tournament Coaches Badge. Coaches admitted to the floor of the event are expected to dress appropriately for a National Championship level event (i.e. dress slacks and golf or polo shirts or warm-up suits preferred. No tank tops, cut off shorts or T-shirts) No Coaches Badge will be issued on day of competition. SPECTATOR ADMISSION TICKETS: Admission for each day of competition will be: children under 9 free, yrs old- $10, Adults $ 15 Tickets will be available for purchase at Registration or purchase at door. Competitors with proper credentials, coaches with proper credentials, referees, USJF and USJA Life Members with proof of active Life membership status will be given free admission. Page 9 of 18

10 Sanctioned Event # OFFICIAL INDIVIDUAL SHIAI COMPETITION ENTRY FORM (Championships Shiai Contestants Only) Payment Options Amount $ Payment Method Certified Check Money Order Personal Check Competitor Information Name (Last) (First) Address City State Country Zip Code Parent(s)/Legal Guardian(s) Phone: Club Name Instructor s Name Club Judo Rank USJF USJA USA Judo Country (for Foreign contestant) Membership (or Foreign Passbook) # Expiration Date (mm/dd/yyyy) DIVISIONS (Please check one) Male Female Bantam : Born 2006 Intermediate 1: Born Intermediate 2: Born Juvenile A : Born Juvenile B : Born IJF Junior (USA only) : Born IJF Junior Open: Born Contestant must be born in the eligible year. No age waivers will be considered or accepted. Juvenile B contestants have the option to compete in the IJF Junior category in addition to or instead of, their own age/weight division. If assistance/accommodation is needed (check off appropriate box): Vision Loss/Blindness Hearing Loss/Deafness Type of assistance/accommodation requested or name of person assisting: IMPORTANT! Do not forget to include the following: Proof of age (government issued birth certificate or passport, verified USA Judo or USJF card with V besides the birth date) NOT ACCEPTABLE: Driver s licenses, church records, hospital certificates, school ID cards, etc. Proof of membership (copy of membership card) Consent for competition bracket change Medical release Signature of parent/legal guardian if contestant is under 18 years of age on all appropriate forms The CHECK LIST of required documents is required to be submitted with application form Passport size (or equivalent) head shot photo to be used for contestant badge Page 10 of 18

11 Sanctioned Event # OFFICIAL KATA ENTRY FORM (Tori and Uke Must Submit Separate Forms For Each Kata) Payment Options Amount $ Payment Method Certified Check Money Order Personal Check Competitor Information Name (Last) (First) Address: City State Country Zip Code Parent(s)/Legal Guardian(s) Phone Club Name Judo Rank Instructor Name Instructor USJF USJA USA Judo Membership # Expiration Date (mm/dd/yyyy) / / KATA PARTNER S NAME Name (Last) (First) Nage No Kata Junior: First three sets of kata Youth: All five sets of kata Katame No Kata Junior: First two sets of kata Youth: All three sets of kata Ju No Kata Junior: First two sets of kata Youth: All three sets of kata Junior: Born inclusively Male, Female or Mixed Teams Allowed Youth: Born inclusively Male, Female or Mixed Teams Allowed Select Kata: Nage No Kata Katame No Kata Ju No Kata Select Kata Division: Junior Youth Select Kata Role: Tori Uke If assistance/accommodation is needed (check appropriate box): Vision Loss/ Blindness Hearing Loss/ Deafness Type of assistance/accommodation requested or name of person assisting: For Each Kata the Team is entering, each Team member must fill out his/her own entry form and list Partner s name. Team must submit the proper fees and application for Each Kata category. The actual team member s name must be stated on the application form and sent in as One application. Kata applications sent in separately will be returned as incomplete. If contestant is under 18 years of age, Parent/Legal Guardian must sign the proper forms. No exceptions. All forms must be completed and attached to the Entry Form. Please use the Check-off list of items to ensure you send in a complete Registration Packet Page 11 of 18

12 ,5th Annual Grassroots Judo Junior, Youth, Team & Kata National Championships WARNING! WAIVER AND RELEASE OF LIABILITY AND AGREEMENT TO PARTICIPATE In consideration of being permitted to participate in any way, including travel to and from the 2014 Grassroots Judo Junior, Youth, Team & Kata National Championships, in any Judo tournament, practice, clinic, and related events and activities ( Activity ) of the United States Judo Federation, Inc., United State Judo Association, Inc., USA Judo/United States Judo, Inc., 50 th State Judo Association, Inc., Neal Blaisdell Center, Ohana Hotels, 2014 Grassroots Judo Junior, Youth, Team & Kata National Championships, and Staff, I agree: 1. I understand the nature of Judo activities and believe I am qualified to participate in such Activity. I also understand the rules governing the sport of Judo. 2. I further acknowledge that prior to participating, I will inspect the mats, equipment, facilities, competition pools or divisions, and the elimination or scoring system to be used, and if I believe anything is unsafe or beyond my capability, I will immediately advise my coach, supervisor, and/or a tournament official of such conditions and refuse to participate. 3. I acknowledge and fully understand that I will be engaging in a contact sport that might result in serious injury, illness or disease, including permanent disability or death, and severe social and economic losses due not only to my own actions, inactions or negligence, but also to the actions, inactions, or negligence of others, the rules of the sport of Judo, or conditions of the premises or of any equipment used. Further, I acknowledge that there may be other risks not known to me or not reasonably foreseeable at this time. 4. Knowing the risks involved in the sport of Judo, I assume all such risks and accept personal responsibility for the damages following such injury, illness, disease, permanent disability, or death. 5. I hereby release, waive, discharge and covenant not to sue the United States Judo Federation, Inc., United States Judo Association, Inc., USA Judo/United States Judo, Inc., 50 th State Judo Association, Inc., Neal Blaisdell Center, Ohana Hotels, 2014 Grassroots Judo Junior, Youth, Team & Team National Championships, and Staff, together with their affiliated clubs, their respective administrators, directors, officers, agents, coaches, and other employees or volunteers of the organization, event officials, medical personnel, other participants, their parents, legal guardians, supervisors and coaches, sponsoring agencies, sponsors, advertisers, and if applicable, owners, lessors, and lessees of premises used in conducting the event all of whom are hereinafter referred to as Releasees from any and all litigation expenses, attorney fees, loss, liability, damage or costs n account of injury, illness, disease, including permanent disability and death or damage to property, caused or alleged to be caused in whole or in part by the negligent acts or omissions of the Releasees or otherwise to the fullest extent permitted by law. I HAVE READ THE ABOVE WARNING, WAIVER, AND RELEASE, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND KNOWING THIS, SIGN IT VOLUNTARILY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE. I AGREE TO PARTICIPATE KNOWING THE RISKS AND CONDITIONS INVOLVED AND DO SO ENTIRELY OF MY OWN FREE WILL. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENT/LEGAL GUARDIAN AS EVIDENCED BY THEIR SIGNATURE BELOW. I INTEND THIS TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THAT THE BALANCE, NOTWITHSTANDING SHALL CONTINUE IN FULL FORCE AND EFFECT. Participant Participant s Signature Date FOR PARENTS/LEGAL GUARDIANS OF PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT TIME OF REGISTRATION) This is to certify that I, as parent/legal guardian with legal responsibility for this participant, do consent and agree to his/her release, as provided above, of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child s involvement or participation including litigation expenses, attorney fees, loss, liability, damage or costs which may incur as the result of the minor child s participation in these programs as provided above, even if arising from their negligence, to the fullest extent permitted by law. I have instructed the minor participant as to the above warnings and conditions and their ramifications. Parent/Legal Guardian s Name Parent/Legal Guardian s Signature Date Page 12 of 18

13 CERTIFICATE REGARDING PARTICIPANT S ABILITY (All NON-BLACK BELT Contestants) I,, a Judo Instructor, who has been awarded the Judo rank of Shodan or higher, under the auspices of the United States Judo Federation Inc., United States Judo Association Inc., USA Judo/United States Judo Inc., hereby certify that (contestant), although not having been awarded the rank of Shodan or higher is of sufficient aptitude and skill in Judo to participate in the 5 th Annual Grassroots Judo Junior, Youth, Team & Kata National Championships. Signature of Judo Sensei / Instructor Date Signature of Parent / Legal Guardian (if contestant is under 18 years of age) Date CONSENT FOR WEIGHT DIVISION CHANGE (All Contestants) & AGE DIVISION CHANGE (Juvenile B ONLY) We (I), the undersigned parent(s) or legal guardian(s) of (contestant), have been informed of the following method of competition for the 5 th Annual Grassroots judo Junior, Youth, Team & Kata National Championships. We (I), hereby express our consent and approval that in the event that the contestant is in an uncontested division, he or she may move up into another weight bracket. We (I), DO NOT consent to a change in weight division under any circumstances. (INITIAL) We (I), DO consent to a change in weight division, the next higher weight division in the same age category if their original division is uncontested. (INITIAL) We (I), DO consent being in Juvenile B, may compete in the IJF Junior category in addition to their own age category. (INITIAL) We (I), DO consent being Juvenile B, may compete in the IJF Junior category instead of their own age category. (INITIAL) Contestant s Name Signature Date Parent / Legal Guardian Name Signature Date (if contestant is under 18 years of age) Page 13 of 18

14 MEDICAL RELEASE AND CONSENT TO THE TREATMENT OF A MINOR (Any contestant under the age of 18) Name ( Last) (First) Address e mail: City State Country Zip Code Date of Birth: (mm/dd /yyyy) Age Gender USJF USJA USA Judo Membership # Expiration Date (mm/dd /yyyy) Parent(s) / Legal Guardian(s) Phone: In emergency, parent(s) /legal guardian(s) can be reached at during tournament. Phone: I (we), the undersigned parent(s) / legal guardian(s) of a minor, do hereby authorize the United States Judo Federation, its Tournament Director, Referee Director, and any and all Organizers, Promoters, Officers, Staff, Referees, Tournament Workers, and Volunteers of the 5 th Annual Grassroots Judo Junior, Youth, Team & Kata National Championships, hereafter referred to as the Championships, as agent(s) for the undersigned to consent to any x-ray examination, anesthetic, medical or surgical diagnosis, or treatment and hospital care which is deemed advisable by, and is to rendered under the general or special supervision of any physician and surgeon, licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. PARENT / LEGAL GUARDIAN PLEASE INITIAL It is understood that this authorization is given in advance of any specific diagnosis, treatment of hospital care being required, but is given to provide authority and power on the part of our aforesaid agent(s) to give specific consent to any and all such diagnosis, treatment or hospital care which the aforementioned physician, in the exercise of his best judgement, may deem advisable. PARENT / LEGAL GUARDIAN PLEASE INITIAL It is understood that the parent(s)/legal guardian(s) of are responsible for all costs that may be incurred as a result of the diagnosis, treatment or hospital care while traveling to or competing in the Championships. It is also understood that the Championships/agent(s) will contact the parent(s)/legal guardian(s) at the first opportunity available, but will have the welfare of the injured minor as a first priority. In the event that the parent(s)/legal guardian(s) are unable to make decisions concerning the need for medical diagnosis, treatment or hospital care, either a Championships official or, in the event of a life or death threatening situation, a proper authority (police, fire, rescue, medical, etc) will be authorized to give consent for diagnosis, treatment or hospital care. PARENT / LEGAL GUARDIAN PLEASE INITIAL The undersigned has carefully read and voluntarily signed the MEDICAL RELEASE AND CONSENT TO THE TREATMENT OF A MINOR form, and further agrees that no oral representations, statements or inducements apart from the foregoing written have been made; and that the undersigned understands that this contract constitutes a MEDICAL RELEASE AND CONSENT TO THE TREATMENT OF A MINOR. PARENT / LEGAL GUARDIAN PLEASE INITIAL Signature of Parent or Legal Guardian: Date: Page 14 of 18

15 MEDICAL RELEASE AND CONSENT TO THE TREATMENT (Any Contestant 18 years or older) I hereby grant permission and consent in the case of possible injury or any injury that may occur during the 5 th Annual Grassroots Judo Junior, Youth, Team & Kata National Championships, as will be referred to as the Championships hereinafter, for the organizers of the Championships to provide me with an athletic trainer, paramedic and/or a doctor to examine me, and if needed, in their opinion, to provide me the medical assistance and/or assistance and/or treatment and transportation, if needed, to a medical facility for a more extensive and comprehensive examination, including X-rays, anesthetic, medical or surgical diagnosis or treatment, and hospital care if deemed advisable by the medical staff of the Championships or of the hospital. I agree to accept all financial obligations incurred as a result of any medical assistance, treatment and related expenses provided in connections with any injuries which I may receive during this Championships, (Participant) Print Clearly: Signature Date POWER OF ATTORNEY (Any contestant under the age of 18 whose parent(s)/legal guardian(s) will not attend) I (We) the parent(s) or legal guardian(s) of (participant) have made, constitute and appoint my (our) true and lawful attorney for me (us) and in my (our) name(s), place, and stead to do any and every act and exercise any and every power that I (we) might or could do or exercise through any other person and that he/she shall deem proper or advisable, intending hereby to vest in her/him, irrevocable and fill power and authority to do and perform every act and thing whatsoever requisite and necessary to be done in connection with the Participant participating in the 5 th Annual Grassroots Judo Junior, Youth, Team & Kata National Championships, registering for the events, receiving medical treatment and make any other decision as I (we) might or could make or do is personally present. Parent / Legal Guardian Signature Witness Signature Date FALSE ALARM / DAMAGES STATEMENT / SPIRIT OF JUDO CLAUSE This form certifies that the competitor, his/her instructor and parent(s) / legal guardian(s) understand that an emergency vehicle response to a false fire alarm may result in serious injury and loss of life, and that a fine, imprisonment and other possible legal consequences may result from activating any false alarm in connection with participation in this tournament. In addition, charges assessed for a false alarm or other damage to tournament and hotel facilities shall, together with the cost and fees incurred with collecting said charges, shall be the responsibility of the perpetrator s parent(s) / legal guardian(s) and home dojo. These Championships are an opportunity to showcase the best Junior competitors, coaches/instructors and officials from the United States and foreign visitors. The intensity and excitement of the events will be high. The Spirit of Judo, however, must be maintained. Respect for and from all competitors, coaches, officials and spectators towards each other will be expected. Individuals determined to be detrimental to this ideal through their physical or vocal actions may be asked to leave the site or if a competitor, be removed from competition. The Tournament Director, with the consultation of appropriate Tournament officials will make the final decision. THIS PROVISION IS UNDERSTOOD. Competitor ( Print Name) Competitor Signature ( REQUIRED) Date Judo Instructor ( Print Name) Judo Instructor Signature (REQUIRED) Date Parent / Legal Guardian (Print Name) Parent. Legal Guardian Signature (REQUIRED) Date (if the contestant is under 18 years of age) Page 15 of 18

16 Spectator Tickets Pre-Sale Competitor s Name (Last) (First) Address City State Zip Competitors and Registered Coaches will not need tickets for the competition days. Children 9 and under get in free. Per day price during Registration and at the door will be: Students 10 years 17 years : $10 Adults: $ 15 * Special 3-day (2 day Junior + Sunday s Senior Nationals) tickets : Students- 3 for $25 Adults - 3 for $39 (*special 3 ticket offer only available during Early registration period to May 18, 2014) Requested Number of Student $10 each per day Requested Number of Student (3 day $25 Requested Number of Adult $15 each per day Requested Number of Adult (3 day $39 Total Cost $ Payment with check or money order (no cash) made out to: 50 th State Judo Association Pre-sale orders will be available at Registration for pick-up Page 16 of 18

17 CHAMPIONSHIPS SHIAI & KATA ENTRY REQUIREMENT CHECKLIST Official Shiai or Kata Entry Form w/ Entry Fee (Remember Kata is by Team entry) Page 10 & 11 Warning, Waiver, Release of Liability and Agreement to Participate Page 12 Certificate Regarding Participants Ability, Consent for Weight Division Change (ALL DIVISIONS) and Age Division Change (JUVENILE B ONLY) Page 13 Medical Release for Treatment of a Minor (under 18) Page 14 Medical Release and Consent to Treatment (18 and over), Power of Attorney, False Alarm/ Damages/ Spirit of Judo Statement Page 15 Photocopy of current USJF, USJA, or USA Judo Membership Card Be sure to bring your membership card to registration checkin. Photocopy of Proof of Age (government issued) birth certificate, passport, USJA or USA Judo membership card with verification symbol V printed following birth date Copy of Black Belt Certificate: for Proof of Rank or Instructor s copy regarding Non-Black Belt Contestant Passport size (or equivalent) head shot photo for contestant badge Spectator s Tickets Pre-Sale Page 16 CHECK LIST SHEET Page 17 Please send in entry forms with all documentation in the ORDER as listed above with a CHECK MARK in front of each item on this CHECK LIST so that we may expedite your registration. PLEASE CHECK THAT ALL SIGNATURE SECTIONS ARE COMPLETED CORRECTLY MISSING OR INCOMPLETE ITEMS WILL NEED TO BE COMPLETED ON REGISTRATION DAY OR ENTRY WILL NOT BE ACCEPTED. ENTRIES WITH INCOMPLETE OR MISSING INFORMATION WILL BE CHARGED THE WALK-UP REGISTRATION FEES. CONTESTANTS MUST STILL CHECK IN/ WEIGH IN ON THE DAY OF REGISTRATION: THURSDAY, July 3 rd 2014, from 9 am to 5 pm Page 17 of 18

18 Coaches Credentials Application Form Each Club will be allowed a Free Coaches Badge to be mat side for a maximum of 1 coach per mat or one per number of contestants from that club (whichever is less) for both these Championships and the USJF Senior Tournament. There will be six (6) contest areas = maximum of six (6) coaches. For additional Coaches badge, beyond your dojo's maximum allotment, a fee of $ 45 each will be charged. Coaches badge (Competition Floor Pass Credentials) will be provided to Nationally Certified Coaches (USJF, USJA or USA Judo), provided that the coach s credential application form is received and postmarked on or before June 18, Coaches who walk-up and register on Thursday, July 3, 2014 must provide all necessary forms and documents. Coaches Badge fee will be $50 each. All applications for Coaches Badges must be submitted together as a Club with photocopies of all necessary documentation. All memberships and certifications must be current throughout the entire event! Required Documentation: Copy of current coaches certification from USJF, USJA, USA Judo or National Federation Copy of current membership in USJF, USJA, USA Judo or National Federation Any required fees (if applicable) ALL Coaches must check-in on Thursday, 7/3/2014 between 9:00 am to 5:00 pm NO Coaches Badges will be issued on day of competition PLEASE PRINT CLEARLY: Club: Head Instructor: Contact person: (Telephone) COACH NAME USJF, USJA OR USA Judo Member # EXP. Date 1) 2) 3) 4) 5) 6) All coaches will be required to dress appropriately. Business casual attire, sweat suit with white polo shirt, dress jeans (no holes, markings), button down shirt or polo. Dress shoes, tennis shoes. No t-shirt, tank tops, sandals, flipflops. Any coaches badge may be revoked upon request by the Tournament Director(s). The coach will lose access to matside for any action deemed necessary by the Tournament committee. Please send this application and necessary forms with fee (if applicable) to: 50 th State Judo Association c/o Ray Imada Malukai Place, Kaneohe, Hawaii Page 18 of 18

Taishi Judo Club 5 th Annual Invitational Tournament

Taishi Judo Club 5 th Annual Invitational Tournament Taishi Judo Club 5 th Annual Invitational Tournament Date/Time: Location: Sunday, March 22, 2015. Tournament will start promptly at 10:00AM Northview High School 1016 W. Cypress St. Covina, CA 91722 Sanction:

More information

Barstow Judo Club Invitational Judo Tournament

Barstow Judo Club Invitational Judo Tournament Barstow Judo Club Invitational Judo Tournament Date: Sunday June 24, 2012 Location: Eligibility: Entry Fee: Awards: Sanction: Cora Harper Community Center 841 Barstow Road Barstow, CA 92311 MUST BE Current

More information

2014 NEW JERSEY STATE JUDO CHAMPIONSHIP Sanctioned by USJF #

2014 NEW JERSEY STATE JUDO CHAMPIONSHIP Sanctioned by USJF # 2014 NEW JERSEY STATE JUDO CHAMPIONSHIP Sanctioned by USJF # 14-03-11 Sunday, March 23, 2014 New Location: Princeton High School 151 Moore St, Princeton, NJ 08540 (Entrance is around back on Walnut St)

More information

10 th Annual Creepy Crawly NeWaza Tournament October 17 th E Eagle River Loop Rd Eagle River, Alaska

10 th Annual Creepy Crawly NeWaza Tournament October 17 th E Eagle River Loop Rd Eagle River, Alaska 10 th Annual Creepy Crawly NeWaza Tournament October 17 th 2015 10126 E Eagle River Loop Rd Eagle River, Alaska Hosted by: Greatland Martial Arts UAA Judo and Jiu Jitsu Sanctioned by: USA Judo Sanction

More information

Taishi Judo Club 5 th Anniversary Invitational Tournament

Taishi Judo Club 5 th Anniversary Invitational Tournament Taishi Judo Club 5 th Anniversary Invitational Tournament Date: Sunday, February 21, 2016. Time: Location: Tournament will start promptly at 10:00AM Cerritos College 11110 Alondra Boulevard Norwalk, CA

More information

SIXTY-SECOND ANNUAL PALO ALTO JUDO TOURNAMENT. Registration Information. Contest Information

SIXTY-SECOND ANNUAL PALO ALTO JUDO TOURNAMENT. Registration Information. Contest Information SIXTY-SECOND ANNUAL PALO ALTO JUDO TOURNAMENT The Sixty-second Palo Alto Judo Tournament will be held in Ayers Gym at Menlo-Atherton High School on Sunday, November 15, 2015. The school address is 555

More information

2014 NIKKEI GAMES JUDO SHIAI & KATA TOURNAMENT Sponsored by the Nikkei Games Coordinating Council

2014 NIKKEI GAMES JUDO SHIAI & KATA TOURNAMENT Sponsored by the Nikkei Games Coordinating Council Date / Time: Sunday, August 10, 2014 / Kata Competition 9:00 AM - Shiai Competition 10:00 AM Location: Long Beach Pyramid-California State University, Long Beach 1250 Bellflower Blvd., Long Beach, CA 90840

More information

Tech Judo Open II Invitational Judo Tournament

Tech Judo Open II Invitational Judo Tournament Tech Judo Open II Invitational Judo Tournament USA Judo Sanction # 2015-12-02 Date: Sunday, February 15, 2015 Tournament Director: Clyde Worthen Tournament Coordinator: Leonardo Victoria Head Referee:

More information

The Ruben Martin Open Judo Championships

The Ruben Martin Open Judo Championships The Ruben Martin Open Judo Championships Sponsored by: ROUND ROBIN FOR DIVISIONS OF 5 OR LESS TRUE DOUBLE ELIMINATION FOR 6 OR MORE AT LEAST 3 MATCHES FOR MOST JUNIORS JUNIOR NOVICE DIVISIONS (up to one

More information

50th Annual Dallas Invitational Judo Championships

50th Annual Dallas Invitational Judo Championships 50th Annual Dallas Invitational Judo Championships Sponsored by: ROUND ROBIN FOR DIVISIONS OF 5 OR LESS TRUE DOUBLE ELIMINATION FOR 6 OR MORE AT LEAST 3 MATCHES FOR MOST JUNIORS JUNIOR NOVICE DIVISIONS

More information

2013 Mid-West Collegiate Championships February 9, 2013

2013 Mid-West Collegiate Championships February 9, 2013 2013 Mid-West Collegiate Championships February 9, 2013 Host: Purdue Judo Club Location: Purdue University Sanction: USA Judo Recreational Sports Center Indiana Judo Inc. 355 N. Martin Jischke Drive West

More information

Charity Event Hosted by the Riverside Youth Judo Club USJA Sanctioned Regional Tournament - # DATE SATURDAY October 15th, 2016

Charity Event Hosted by the Riverside Youth Judo Club USJA Sanctioned Regional Tournament - # DATE SATURDAY October 15th, 2016 Charity Event Hosted by the Riverside Youth Judo Club USJA Sanctioned Regional Tournament - #16-033 DATE SATURDAY October 15th, 2016 LOCATION Ramona High School 7675 Magnolia Avenue Riverside, CA 92504

More information

Hui-O-Judo Beltsville and College Park Judo Club

Hui-O-Judo Beltsville and College Park Judo Club Hui-O-Judo Beltsville and College Park Judo Club Ken Tamai Memorial Judo Championships Saturday, October 29, 2016 Site: DeMatha Catholic High School, 4318 Madison St, Hyattsville, Maryland, 20781 Convocation

More information

The 2015 U.S. Open Veterans Judo Championships Fort Lauderdale, Florida Sponsored by A. Kolychkine Judo Foundation

The 2015 U.S. Open Veterans Judo Championships Fort Lauderdale, Florida Sponsored by A. Kolychkine Judo Foundation The 2015 U.S. Open Veterans Judo Championships Fort Lauderdale, Florida Sponsored by A. Kolychkine Judo Foundation Held under the Sanction (2014-04-07) of USA JUDO (United States Judo, Inc.) Domestic &

More information

Cherry Blossom Open XXII

Cherry Blossom Open XXII Cherry Blossom Open XXII Saturday, February 13, 2016 National Ranking Points: Bantam, Intermediate, & Juvenile A & B only - 2 for 1st, 1 for 2nd, and.5 for 3rd Hosted by: Tomodachi Judo Club & Ki-Itsu-Sai

More information

2016 Texas Judo Inc. NCJA Southwest Regional Collegiate Championships

2016 Texas Judo Inc. NCJA Southwest Regional Collegiate Championships HOST: ELIGIBILITY: Texas A&M University Judo Team http://aggiejudo.com Texas, Oklahoma, Louisiana, Arkansas, Mississippi & New Mexico full time college students. See eligibility requirements on page 3

More information

Cherry Blossom Open XXI Judo Championship

Cherry Blossom Open XXI Judo Championship Cherry Blossom Open XXI Judo Championship National Ranking Points: Bantam, Inter., & Juve. A only - 2 for 1st, 1 for 2nd, and.5 for 3rd Dates: Hosted by: Saturday, January 31, 2015 Bantam 1, 2, 3 & Juvenile

More information

Minnesota State Open Judo Championship Saturday May 2, 2009 (USJI Sanction JMI #0902)

Minnesota State Open Judo Championship Saturday May 2, 2009 (USJI Sanction JMI #0902) Minnesota State Open Judo Championship Saturday May 2, 2009 (USJI Sanction JMI #0902) SCHEDULE OF EVENTS A LOCATION s Friday, May 1, 2009 (Midway Judo Club) 6:00 PM 8:00 PM Referee s Clinic ($10.00 fee

More information

IOWA STATE UNIVERSITY SPRING JUDO CHAMPIONSHIP

IOWA STATE UNIVERSITY SPRING JUDO CHAMPIONSHIP IOWA STATE UNIVERSITY SPRING JUDO CHAMPIONSHIP DATE: Sunday, April 21, 2012 LOCATION: Forker Building, Iowa State University, Ames, Iowa SANCTION: Applied for WEIGH-INS: 8:00 10:00 AM COMPETITION: Juniors

More information

2016 Michigan State Games Judo Sanction: USJF# 16-06-05 http://stategamesofmichigan.com/judo http://konanjudo.wordpress.com/

2016 Michigan State Games Judo Sanction: USJF# 16-06-05 http://stategamesofmichigan.com/judo http://konanjudo.wordpress.com/ DATE: Saturday, June 25, 2016 LOCATION: Kroc Center 2500 S. Division Street. NE Grand Rapids, MI 49507 ELIGIBILITY: All contestants must provide a valid U.S.J.F., U.S.J.I., or U.S.J.A. card. Foreign contestants

More information

Junior, Senior and Master Shiai & Kata Judo Tournament

Junior, Senior and Master Shiai & Kata Judo Tournament TOHKON 16 16 Junior, Senior and Master Shiai & Kata Judo Tournament Regional Referee Testing Site Saturday, June 4, 2011 Oak Lawn Community Pavilion 9401 Oak Park Avenue Oak Lawn, Illinois 60453 Tohkon

More information

OHIO JUDO, INC. presents the. March 7th, 2015

OHIO JUDO, INC. presents the. March 7th, 2015 OHIO JUDO, INC. presents the March 7th, 2015 Hosted By: Ameri-Kan Judo & Chu-To-Bu Judo Bluffton University Founders Hall Bluffton, Ohio "The Olympic Sport of Judo" Before and after practicing Judo or

More information

2017 USJA / USJF Grassroots Judo Summer Nationals

2017 USJA / USJF Grassroots Judo Summer Nationals 2017 USJA / USJF Grassroots Hosted by the Tomodachi Judo Club July 6-9, 2017 Palm Beach Convention Center West Palm Beach, Florida Book room early to get Judo rate $115 +tax No car rental needed! Host

More information

Short Fitness Center MacDill Air Force Base, Tampa, Florida LIMITED TO 50 LIFTERS. ENTRY FORMS WILL NOT BE ACCEPTED AFTER DECEMBER 7th, 2012

Short Fitness Center MacDill Air Force Base, Tampa, Florida LIMITED TO 50 LIFTERS. ENTRY FORMS WILL NOT BE ACCEPTED AFTER DECEMBER 7th, 2012 DATE RECEIVED: PAID: Check Cash Money Order 2012 A.A.U. ARMED FORCES PUSH/PULL & SINGLE LIFT CHAMPIONSHIPS 2012 AAU FLORIDA STATE PUSH/PULL & SINGLE LIFT CHAMPIONSHIPS Saturday, December 15, 2012 Short

More information

2017 Wahadachi & WJI State Judo Championship

2017 Wahadachi & WJI State Judo Championship 2017 Wahadachi & WJI State Judo Championship Dear Fellow Judoka, We are excited to announce that we will be hosting our annual Wahadachi and WJI State Judo Championship on Sunday, January 29, 2017. We

More information

(AAU) Basketball June 10-12, 2016

(AAU) Basketball June 10-12, 2016 (AAU) Basketball June 10-12, 2016 AL. State Games Contact Charles Ferguson 334-440-8253 charles.ferguson@asffoundation.org Tournament Director (AAU DIVISION) Franklin Williams 334-618-5229 dothangymrats@yahoo.com

More information

2010 USJA/USJF WINTER NATIONALS SENIORS MASTERS JUNIORS KATA

2010 USJA/USJF WINTER NATIONALS SENIORS MASTERS JUNIORS KATA 5 th ANNIVERSARY 2010 USJA/USJF WINTER NATIONALS SENIORS MASTERS JUNIORS KATA SATURDAY & SUNDAY DECEMBER 4 & 5, LA VERNE, CA Hosted by GOLTZ JUDO TOURNAMENT DIRECTOR: Gary Goltz HEAD REFEREE: Hayward Nishioka

More information

43 rd U.S. National Indoor Championships JOAD National Indoor Championships March 9 11, 2012

43 rd U.S. National Indoor Championships JOAD National Indoor Championships March 9 11, 2012 GENERAL GUIDELINES: This is the registration information for Harrisonburg, Virginia. *Sanctioned by USA Archery and Registered with World Archery as a Star Event. The U.S. National Indoor Championships

More information

Universal Judo Training Camp

Universal Judo Training Camp Universal Judo Training Camp Jim Hrbek, 1992 US Olympic Coach HOURS of Judo training instead of minutes of competition Hosted by Universal Judo Club San Antonio, TX Date: July 5 through 10, 2011 OR Weekend

More information

C e n t r a l A A U R e g i o n a l V I K a r a t e C h a m p i o n s h i p s. April 24-26, 2015 Grayslake, Illinois

C e n t r a l A A U R e g i o n a l V I K a r a t e C h a m p i o n s h i p s. April 24-26, 2015 Grayslake, Illinois C e n t r a l A A U R e g i o n a l V I K a r a t e C h a m p i o n s h i p s April 24-26, 2015 Grayslake, Illinois DATE: April 24- April 26, 2015 TIME: LOCATION: HOST: Friday 4-24 - clinics 6 PM - 8 PM

More information

2016 Kansas City Table Tennis Fall Classic

2016 Kansas City Table Tennis Fall Classic 2016 Kansas City Table Tennis Fall Classic Thank You to Our Sponsors: Hosted by Kansas City Table Tennis and the Overland Park Athletic Club 2-Star tournament sanctioned by USATT $2500 in Prize Money +

More information

Minnesota State Open Judo Championship Saturday May 1, 2010 (USJI Sanction JMI #Applied for)

Minnesota State Open Judo Championship Saturday May 1, 2010 (USJI Sanction JMI #Applied for) Minnesota State Open Judo Championship Saturday May 1, 2010 (USJI Sanction JMI #Applied for) SCHEDULE OF EVENTS A s Friday, April 30, 2010 (Midway Judo Club) 6:00 PM 8:00 PM Referee s Clinic ($10.00 fee

More information

Release of Liability. Printed Name of Participant:

Release of Liability. Printed Name of Participant: Release of Liability IN CONSIDERATION of being given the opportunity to participate in any USRowing activity, including scheduled, supervised club activities, and registered regattas, during the policy

More information

USA Judo Coach Education and Certification, USA Judo Teacher s Certification and Advanced Judoka Clinic

USA Judo Coach Education and Certification, USA Judo Teacher s Certification and Advanced Judoka Clinic The USA Judo Coach and Education Committee and The National Teachers Institute in cooperation with the Washington Judo Club and Georgetown University Present: USA Judo Coach Education and Certification,

More information

22nd Annual Go Shibata Memorial & Brown Belt Championships Texas Judo Inc All Star Event

22nd Annual Go Shibata Memorial & Brown Belt Championships Texas Judo Inc All Star Event HOST: Judo Team www.aggiejudo.com DATE: LOCATION: Physical Education Activity Building (PEAP) 632 Penberthy Road College Station, Texas 77843 SANCTION: USA Judo Sanction #11162 WEIGH-IN: Weigh-in and Registration

More information

2015 STIGA PORTLAND OPEN. Two Star Table Tennis Tournament. November 14th and 15th, 2015

2015 STIGA PORTLAND OPEN. Two Star Table Tennis Tournament. November 14th and 15th, 2015 2015 STIGA PORTLAND OPEN Two Star Table Tennis Tournament November 14th and 15th, 2015 TUALATIN HILLS ATHLETIC CENTER 50 NW 158TH (158th and Walker Road) Beaverton, OR 97006 (503-629-6330) SANCTIONED BY

More information

JAYS KIDS WRESTLING CLUB (PLEASE PRINT) Street Address: City: ZIP: School Attending: Birth Date:

JAYS KIDS WRESTLING CLUB (PLEASE PRINT) Street Address: City: ZIP: School Attending: Birth Date: JAYS KIDS WRESTLING CLUB (PLEASE PRINT) Wrestler s Name: Parent/Legal Guardian s Names: Street Address: City: ZIP: Home Phone: Cell Phone: School Attending: Birth Date: Work Phone: Email: Grade: Age: I

More information

Release of General Liability for Riders and Horse Owners Participant Name: Clinic Venue:

Release of General Liability for Riders and Horse Owners Participant Name: Clinic Venue: LESLIE DESMOND HORSE & RIDER TRAINING WORKSHOPS * * * THIS IS A VOLUNTARY RELEASE OF LIABILITY * * * IT IS ALSO A BINDING "ASSUMPTION OF RISK AND INDEMNITY" CONTRACT YOU ARE ADVISED TO READ AND UNDERSTAND

More information

INTERNATIONAL JUDO CHALLENGE GALLAGHER CENTER at NIAGARA UNIVERSITY NIAGARA FALLS, NY USA

INTERNATIONAL JUDO CHALLENGE GALLAGHER CENTER at NIAGARA UNIVERSITY NIAGARA FALLS, NY USA INTERNATIONAL JUDO CHALLENGE GALLAGHER CENTER at NIAGARA UNIVERSITY NIAGARA FALLS, NY USA SHIAI Juniors-Youth-Masters-Seniors Saturday, May 28, 2016 COMPETITOR PACKET 2016 INTERNATIONAL JUDO CHALLENGE

More information

https://www.facebook.com/bigapplejudoclassic?fref=ts Online registration: https://campscui.active.com/orgs/bigapplejudo

https://www.facebook.com/bigapplejudoclassic?fref=ts Online registration: https://campscui.active.com/orgs/bigapplejudo Facebook: https://www.facebook.com/bigapplejudoclassic?fref=ts Online registration: https://campscui.active.com/orgs/bigapplejudo $1000 prize for the Gold Medal winner of the Senior Elite Open division.

More information

2017 NATIONAL MASTERS WEIGHTLIFTING CHAMPIONSHIPS MARCH 9 MARCH 12, 2017 SAVANNAH, GEORGIA, USA

2017 NATIONAL MASTERS WEIGHTLIFTING CHAMPIONSHIPS MARCH 9 MARCH 12, 2017 SAVANNAH, GEORGIA, USA Presented by Team Savannah Weightlifting, Inc. Competition Venue Entry Fees Mail to Paul Anderson / Howard Cohen Weightlifting Center 7232 Varnedoe Drive Savannah, GA 31406 Individual Early Entry $100.00

More information

2015 NATIONAL KARATE CHAMPIONSHIPS Raleigh, North Carolina. June 30, 2015 thru July 4, 2015

2015 NATIONAL KARATE CHAMPIONSHIPS Raleigh, North Carolina. June 30, 2015 thru July 4, 2015 2015 NATIONAL KARATE CHAMPIONSHIPS Raleigh, North Carolina June 30, 2015 thru July 4, 2015 National Karate Committee Chairman, J.B. Mirza Phone: 847-398-9410 WWW.AAUKARATE.ORG Sanctioned By: Amateur Athletic

More information

ADULT COACHING APPLICATION

ADULT COACHING APPLICATION ADULT COACHING APPLICATION - -MEMBER HRLY Private lessons where non-members and members can come and row in a one-on-one session tailored to your skill level and abilities (Beginners & Experienced rowers).

More information

OSU Judo Club. (Judo Club C.O. Sport Clubs and Intramurals) 211 Dixon Rec. Center Oregon State University Corvallis, OR 97331

OSU Judo Club. (Judo Club C.O. Sport Clubs and Intramurals) 211 Dixon Rec. Center Oregon State University Corvallis, OR 97331 OSU Judo Club (Judo Club C.O. Sport Clubs and Intramurals) 211 Dixon Rec. Center Oregon State University Corvallis, OR 97331 2012 Corvallis Judo Winter Tournament Saturday, February 18 th, 2012, 9:00 AM

More information

2016 ATU FLORIDA STATE TAE KWON DO CHAMPIONSHIP

2016 ATU FLORIDA STATE TAE KWON DO CHAMPIONSHIP 2016 ATU FLORIDA STATE TAE KWON DO CHAMPIONSHIP Dear Grandmasters, Masters, and Instructors: You and your students are invited to participate in 2016 ATU Florida state Tae Kwon Do Championship to be held

More information

WHEN DO I NEED TO DO A FIELD TRIP REQUEST?

WHEN DO I NEED TO DO A FIELD TRIP REQUEST? WHEN DO I NEED TO DO A FIELD TRIP REQUEST? CLUB/ORGANIZATION FIELD TRIP Copies of clubs approved field trip request, Emergency Information Form, RCCD Student Excursion Contract, and Release and Waiver

More information

Sunday, October 16, 2016

Sunday, October 16, 2016 Sunday, October 16, 2016 Dear Coaches and Advisors, It s that time of the year again, where cheerleading gets competitive in WNY! We know how important it is for your athletes to get an unforgettable experience

More information

HOLIDAY CHEER CLASSIC Registration Form

HOLIDAY CHEER CLASSIC Registration Form HOLIDAY CHEER CLASSIC Registration Form Saturday, December 13, 2014 Dunn Center in Elizabeth, NJ PAGE 1 Contact Information: PLEASE PRINT CLEARLY Team/School/Gym/Organization Team Colors Coach Mailing

More information

USSSA WORLD SERIES ST. LOUIS CARDINALS BASEBALL TICKETS ORDER FORM

USSSA WORLD SERIES ST. LOUIS CARDINALS BASEBALL TICKETS ORDER FORM 14 & Under AA/AAA 60/90 Fountain Lakes Complex; St. Louis, Missouri ST. LOUIS CARDINALS BASEBALL TICKETS ORDER FORM This form is being provided for teams to obtain tickets for players, coaches and parents

More information

without a signed waiver Santa Fe, NM 87506 Fax: 505 820 Student Name: City: Zip: State: Physician's Name: Parent Name(s): Parent Address: City:

without a signed waiver Santa Fe, NM 87506 Fax: 505 820 Student Name: City: Zip: State: Physician's Name: Parent Name(s): Parent Address: City: Please mail application to: Las Campanas Compadres, Inc. 15 Buckskin Circle Santa Fe, NM 87506 Fax: 505 820 2709 Las Campanas Compadres, Inc. Student Application Form Please be sure to sign the waiver

More information

2015-16 Insurance Information Insurance coverage

2015-16 Insurance Information Insurance coverage 2015-16 Insurance Information Insurance coverage At USA Wrestling, our top priorities are safety and security. That's why we make sure you're covered by General Liability, Accidental Medical Expense, and

More information

2014 / 2015 Aztec Youth Rugby Club Registration Packet

2014 / 2015 Aztec Youth Rugby Club Registration Packet 2014 / 2015 Aztec Youth Rugby Club Registration Packet Please complete, sign and return all forms along with the following items: Copies of all forms and requested items Full registration fee in advance

More information

Paul Anderson / Howard Cohen Weightlifting Center 7232 Varnedoe Drive Savannah, GA 31406

Paul Anderson / Howard Cohen Weightlifting Center 7232 Varnedoe Drive Savannah, GA 31406 Presented by Team Savannah Weightlifting, Inc. Competition Venue Entry Fees Mail to Paul Anderson / Howard Cohen Weightlifting Center 7232 Varnedoe Drive Savannah, GA 31406 Individual - $90.00 US Team

More information

2015 NEW YORK USA WRESTLING Jumper Leggio KIDS STATE FOLKSTYLE CHAMPIONSHIPS

2015 NEW YORK USA WRESTLING Jumper Leggio KIDS STATE FOLKSTYLE CHAMPIONSHIPS 2015 NEW YORK USA WRESTLING Jumper Leggio KIDS STATE FOLKSTYLE CHAMPIONSHIPS MARCH 7th, 2015 Sullivan County Community College 112 College Rd, Loch Sheldrake, NY 12759 REGISTER BY February 27, 2015 State

More information

Saturday, December 19

Saturday, December 19 proudly present: Saturday, December 19 RULES OF PERFORMANCE SQUAT: The lifter shall face the front of the platform. The bar shall be held horizontally across the shoulders, hands and fingers gripping the

More information

2015 NEW YORK USA WRESTLING Jumper Leggio KIDS STATE FOLKSTYLE CHAMPIONSHIPS

2015 NEW YORK USA WRESTLING Jumper Leggio KIDS STATE FOLKSTYLE CHAMPIONSHIPS 2015 NEW YORK USA WRESTLING Jumper Leggio KIDS STATE FOLKSTYLE CHAMPIONSHIPS MARCH 7th, 2015 Sullivan County Community College 112 College Rd, Loch Sheldrake, NY 12759 REGISTER BY February 27, 2015 State

More information

Finals will be shown live on streaming video. Check www.usopenjudo.com for details.

Finals will be shown live on streaming video. Check www.usopenjudo.com for details. 2016 U.S. Open Jr, Sr & Veterans Judo Championships 28 th Annual US Open Junior Championship! Held under the Sanction of USA JUDO (United States Judo, Inc.) July 22, July 23, July 24, 2016 Hosted by: Sponsored

More information

2016 Wells Football Cheering General Information

2016 Wells Football Cheering General Information 2016 Wells Football Cheering General Information AGE RANGE/SQUAD ASSIGNMENT:! Squads are based on age as of 9/30, they are as follows: FLAG: 5-7 YEARS OLD (10/1/2008 9/30/2011) MINOR: 8-9 YEARS OLD (10/1/2006

More information

Santa Monica College Administrative Regulation - Students Activities and Student Conduct

Santa Monica College Administrative Regulation - Students Activities and Student Conduct Santa Monica College Administrative Regulation - Students Activities and Student Conduct (AR5319-091481) Extracurricular Trips Arrangements for trips by clubs and other non-athletic extracurricular activity

More information

SUMMER DAY CAMP WEINGART-LAKEWOOD FAMILY YMCA REGISTRATION PACKET

SUMMER DAY CAMP WEINGART-LAKEWOOD FAMILY YMCA REGISTRATION PACKET SUMMER DAY CAMP WEINGART-LAKEWOOD FAMILY YMCA REGISTRATION PACKET For office use only: Agency Participant Year Round Participant LBUSD Participant T-shirt received Staff Initials Shirt size: Youth- XS

More information

PROGRAM APPLICATION. Students will be informed via of their acceptance.

PROGRAM APPLICATION. Students will be informed via  of their acceptance. PROGRAM APPLICATION IMPORTANT DATES: Friday, February 27, 2015 Friday, March 13, 2015 Monday, April 20, 2015 Monday, April 20, 2015 Thursday, May 7, 2015 Application and $500 deposit due. Students will

More information

CHICAGO RUNNING TOURS & MORE, LLC WAIVER AND RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT PLEASE REVIEW THOROUGHLY BEFORE SIGNING

CHICAGO RUNNING TOURS & MORE, LLC WAIVER AND RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT PLEASE REVIEW THOROUGHLY BEFORE SIGNING CHICAGO RUNNING TOURS & MORE, LLC WAIVER AND RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT PLEASE REVIEW THOROUGHLY BEFORE SIGNING The undersigned, in consideration of being permitted to participate

More information

SOCCER LEAGUES & TOURNAMENTS

SOCCER LEAGUES & TOURNAMENTS SOCCER LEAGUES & TOURNAMENTS Information Packet General Information Checklist Please read through this packet and make sure that all required documents are completed and returned to Armonk Indoor by mail,

More information

TAEKWONDO AAU REGIONAL CHAMPIONSHIP. TACOMA, WA SATURDAY, APRIL 30, 2011 WINNERS GYM 810 East Harrison Tacoma, WA 98404

TAEKWONDO AAU REGIONAL CHAMPIONSHIP. TACOMA, WA SATURDAY, APRIL 30, 2011 WINNERS GYM 810 East Harrison Tacoma, WA 98404 Fu ex p n co m erie pet env nce in itive iron a men safe t Ele ctr Ma onic s tted cori Rin ng gs TAEKWONDO AAU REGIONAL CHAMPIONSHIP TACOMA, WA SATURDAY, APRIL 30, 2011 WINNERS GYM 810 East Harrison Tacoma,

More information

Invitational. Dame Group & Boss Barbell Club Presents

Invitational. Dame Group & Boss Barbell Club Presents Invitational Dame Group & Boss Barbell Club Presents Open Powerlifting Meet (Raw and Classic Raw) FULL POWER ONLY Limited to the FIRST 90 REGISTERED LIFTERS MUST BE INVITED OR HAVE A CLASS 1 TOTAL TO COMPETE

More information

DATE OF BIRTH: STREET ADDRESS: CITY/STATE/ZIP:

DATE OF BIRTH: STREET ADDRESS: CITY/STATE/ZIP: Get Noticed Beach Volleyball Waiver WAIVER AND RELEASE, EXPRESS ASSUMPTION OF RISK, INDEMNITY AND HOLD HARMLESS AGREEMENT, AND GRANT OF RIGHTS NAME OF PLAYER: PLAYER AGE DATE OF BIRTH: PLAYER GRADE as

More information

22nd Annual CA Open Taekwondo Championship

22nd Annual CA Open Taekwondo Championship Greeting This year's tournament, the 22nd California Open Championship, will be held in the same venue (California State University Dominguez Hills Toro Gym )on October 18th, 2014. To promote a supportive

More information

2014 REGISTRATION FORMS

2014 REGISTRATION FORMS March 28-30, 2014 Universal Orlando Resort 2014 REGISTRATION FORMS Page 1 2014 General Information, Policies & Checklist US Spirit Contact Info For answers to questions or for additional information. Phone:

More information

2015 Coach E s Flagler College Basketball Camps

2015 Coach E s Flagler College Basketball Camps 2015 Coach E s Flagler College Basketball Camps Necci Brown 2015 Averaged a 31.9 field goal percentage during her career as a Saint July 13-17 Camp Registration Campers cannot be admitted without full

More information

Polar Bear Girls Youth Hockey

Polar Bear Girls Youth Hockey Polar Bear Girls Youth Hockey 2015 Tournament Registration Form: Palouse Care Cup Girls Hockey Tournament Feb. 6 th 8 th, 2015 $600 Register: Please complete the information below and return with a team

More information

Houston Livestock Show and Rodeo. Rules & Information 2017

Houston Livestock Show and Rodeo. Rules & Information 2017 Divisions: Competitors will select a division based on age criteria below. Junior, ages 6 to 15 (Must be at least 6 years old and not older than 15 by Dec. 12, 2016.) Senior, ages 16 to 21 (Must be at

More information

OFFENSE DEFENSE SPORTS

OFFENSE DEFENSE SPORTS OFFENSE DEFENSE SPORTS 309 Bush Drive Myrtle Beach, SC 2957 (843) 903-1888 July 2014 Dear Coaches and Parents: Thank you for your interest in the 2014-2015 Offense-Defense Football League National Championship!

More information

2015 Jeff Milano-Johnson Regional Lacrosse Tournament

2015 Jeff Milano-Johnson Regional Lacrosse Tournament 2015 Jeff Milano-Johnson Regional Lacrosse Tournament Registration Package Contents Include: Tournament Details Team Registration Form Team Waiver/Release Form Tournament Rules About the JMJ Tournament

More information

Camp registration now open!

Camp registration now open! Camp registration now open! Open to novice and experienced Belen registered students in grades 6-12 New rowers will learn the basics of crew & experienced rowers will improve their technique and skills

More information

YOUTH FOOTBALL & CHEERLEADING PROGRAM

YOUTH FOOTBALL & CHEERLEADING PROGRAM YOUTH FOOTBALL & CHEERLEADING PROGRAM February 1, 2017 To Parents/Guardians of Football Players: Thank you for allowing your child to play football. We have met many of you, and are looking forward to

More information

2017 SASK OPEN JUDO CANADA REGIONAL RANKING TOURNAMENT JUDO CHAMPIONSHIPS. National A Level Event JAN

2017 SASK OPEN JUDO CANADA REGIONAL RANKING TOURNAMENT JUDO CHAMPIONSHIPS. National A Level Event JAN JAN JUDO CANADA REGIONAL RANKING TOURNAMENT National A Level Event U14 - U16 - U18 - U21 - Seniors - Masters National C Referee Examination Sanctioned by Judo Canada and Judo Saskatchewan REGINAYJUDO@GMAIL.COM

More information

Pasadena YMCA Jr. Lakers Basketball League Summer 2012 Parent Information Sheet

Pasadena YMCA Jr. Lakers Basketball League Summer 2012 Parent Information Sheet Jr. Lakers Basketball League Summer 2012 Parent Information Sheet What is the difference between the basketball clinic and the regular basketball league? The clinic is an intensive 4-week break-down of

More information

2015 FLORIDA SENIOR GAMES Saturday, December 12, 2015

2015 FLORIDA SENIOR GAMES Saturday, December 12, 2015 North Greenwood Recreation Center 900 N. Martin Luther King Jr. Avenue Clearwater, Florida 33755 2015 FLORIDA SENIOR GAMES Saturday, December 12, 2015 From US Highway 19: Take Drew St west for 3.5 miles

More information

Four Seasons Invitational Tae Kwon DO Championships

Four Seasons Invitational Tae Kwon DO Championships Four Seasons Invitational Tae Kwon DO Championships Winter COMPETITION Saturday, March 7, 2015 Dear School Owners, Masters, Instructors, and Students, The is pleased to invite you to the WINTER COMPETITION

More information

APPENDIX B. Adult Check here if the intern is an adult. Minor Check here if the intern is a minor.

APPENDIX B. Adult Check here if the intern is an adult. Minor Check here if the intern is a minor. APPENDIX B Adult Check here if the intern is an adult. Minor Check here if the intern is a minor. IMPORTANT: ALL ADULT INTERNS AGREE: [Insert Name] ( Intern ), by my own request, desire to participate

More information

Please note there is a minimum 2.5 high school G.P.A requirement, and participants must be high school age (freshman thru senior).

Please note there is a minimum 2.5 high school G.P.A requirement, and participants must be high school age (freshman thru senior). Dear Student, Thank you for your interest in attending our Health Career Exploration Camp. The camp will take place on July 18, 19 & 20 at Utah State University-Eastern Blanding Campus. To register for

More information

Texas A&M University-Corpus Christi Youth Program Medical Emergency Information/Consent for Treatment

Texas A&M University-Corpus Christi Youth Program Medical Emergency Information/Consent for Treatment Texas A&M University-Corpus Christi Youth Program Medical Emergency Information/Consent for Treatment Youth s name: Address: Date of birth: Parent/guardian phone: Home Work Pager/Cellular Medical Information

More information

Hurricanes Wrestling Club 2009 & 2011 NCUSAW Elementary Team 1141 A Gibson Rd, Mebane, NC

Hurricanes Wrestling Club 2009 & 2011 NCUSAW Elementary Team 1141 A Gibson Rd, Mebane, NC Hurricanes Wrestling Club 2009 & 2011 NCUSAW Elementary Team 1141 A Gibson Rd, Mebane, NC 27302 Champions!!! Hurricanes Wrestling Club Ages 4 Years of Age 12 th Grade (boys & girls) Storm Chasers (Pre

More information

Motorcycle RiderCourse WAIVERS

Motorcycle RiderCourse WAIVERS Motorcycle RiderCourse WAIVERS General Instructions All pages must be completed and signed. If you have any questions, call (231) 591-5819. Mail completed forms to: Motorcycle Rider Courses, Ferris State

More information

A Message from USA Judo. This year the US Open will be held on Saturday, May 12th at world famous Doral Country Club and Spa in Miami, Florida.

A Message from USA Judo. This year the US Open will be held on Saturday, May 12th at world famous Doral Country Club and Spa in Miami, Florida. A Message from USA Judo Dear Athletes & Coaches: This year the US Open will be held on Saturday, May 12th at world famous Doral Country Club and Spa in Miami, Florida. The competition will be but one day

More information

MARKIN FARMS HOLDINGS, LLC AND ZIP LINE ADVENTURES, LLC LIABILITY WAIVER & AGREEMENT

MARKIN FARMS HOLDINGS, LLC AND ZIP LINE ADVENTURES, LLC LIABILITY WAIVER & AGREEMENT MARKIN FARMS HOLDINGS, LLC AND ZIP LINE ADVENTURES, LLC LIABILITY WAIVER & AGREEMENT Please read and be certain you understand the implications of signing By signing this agreement, I acknowledge that

More information

TARLETON SPORTS MEDICINE. Student-Athlete Medical Information

TARLETON SPORTS MEDICINE. Student-Athlete Medical Information TARLETON SPORTS MEDICINE Student-Athlete Medical Information TARLETON STATE UNIVERSITY ATHLETICS DEPARTMENT Box T-0080 Stephenville, TX 76402 254-968-9178 254-968-9674 FAX www.tarletonsports.com Dear Parent

More information

SON S PREMIER TAEKWONDO CHAMPIONSHIP 2016 May 29 th, 2016 Brampton Soccer Centre

SON S PREMIER TAEKWONDO CHAMPIONSHIP 2016 May 29 th, 2016 Brampton Soccer Centre Dear Master, Instructors, and Taekwondo Practitioners; It is with great pleasure that we invite you to the 2016 Son's Premier Taekwondo Championship to be held at Brampton Soccer Centre in Brampton, Ontario

More information

MEMBERSHIP/BOAT SUPPORT APPLICATION

MEMBERSHIP/BOAT SUPPORT APPLICATION MEMBERSHIP/BOAT SUPPORT APPLICATION Family memberships include no more than two adults per household and their unmarried rowing children under the age of 21 (or currently enrolled in school up to age 23).

More information

SNHSC Home Club Membership

SNHSC Home Club Membership 2013-2014 SNHSC Home Club Membership The Southern New Hampshire Skating Club, a member of United States Figure Skating, offers membership opportunities to its participants and supporters. Becoming a member

More information

Math + Leadership Camp at CSUSM Registration Forms

Math + Leadership Camp at CSUSM Registration Forms Math + Leadership Camp at CSUSM Registration Forms CONTACT INFORMATION Math for America San Diego Email: sandiego@mathforamerica.org Phone: 858-822-6284 Registration Checklist Complete all sections of

More information

2016 INEX MEMBERSHIP APPLICATION

2016 INEX MEMBERSHIP APPLICATION 2016 INEX MEMBERSHIP APPLICATION ONE FORM PER APPLICANT THE ACCEPTANCE OF THIS APPLICATION AND FEE BY INEX DOES NOT CONSTITUTE MEMBERSHIP APPROVAL. INEX MAY DENY MEMBERSHIP TO ANY APPLICANT FOR ANY REASON.

More information

This event is sanctioned by the Amateur Athletic Union of the U. S., Inc. All participants must have a current AAU membership. AAU membership may not

This event is sanctioned by the Amateur Athletic Union of the U. S., Inc. All participants must have a current AAU membership. AAU membership may not AAU GIRLS BASKETBALL 4 TH GRADE DIVISION I, II & III NATIONAL CHAMPIONSHIP ESPN WIDE WORLD OF SPORTS COMPLEX JULY 2 ND 7 TH, 2013 This event is sanctioned by the Amateur Athletic Union of the U. S., Inc.

More information

California Polytechnic State University, Pomona Vietnamese Student Association. Family. Honor. Tradition.

California Polytechnic State University, Pomona Vietnamese Student Association. Family. Honor. Tradition. California Polytechnic State University, Pomona Vietnamese Student Association Family. Honor. Tradition. ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM Name of Activity or Event: CAL POLY POMONA VSA WINTER

More information

Medical Information & Waiver Forms

Medical Information & Waiver Forms Medical Information & Waiver Forms This packet contains medical information forms and a sample waiver and release from liability form. In today's climate of insurance claims and liability action, the use

More information

2013 BRITISH SCHOOLS CHAMPIONSHIPS

2013 BRITISH SCHOOLS CHAMPIONSHIPS Organisation / Entries: Events Team, British Judo Association, Suite B, Loughborough Technology Centre, Epinal Way, Loughborough, LE11 3GE, Great Britain. Tel: +44 (0)1509 631695 Fax: +44 (0)1509 631680

More information

Top Guns AAA Hockey Tournament

Top Guns AAA Hockey Tournament Top Guns AAA Hockey Tournament Calgary, Alberta Manager s Package Top Guns AAA Spring Hockey Tournament The Top Guns committee is pleased to invite your team to participate in the Top Guns AAA Spring Hockey

More information

Amateur Sports Team & League Liability Insurance Application -No Participant Coverage-

Amateur Sports Team & League Liability Insurance Application -No Participant Coverage- Amateur Sports Team & League Liability Insurance Application -No Participant Coverage- Name of Organization: C/O (Individual Responsible for Insurance): Mailing : City: State: Zip: Phone: ( ) Fax: ( )

More information

CHEERLEADING COMPETITION

CHEERLEADING COMPETITION 2012 Delphos Canal Days CHEERLEADING COMPETITION Sunday, September 16, 2012 July 16, 2012 Dear Cheerleading Advisor, We would like to invite you to Canal Days 18 th Annual Cheerleading Competition. This

More information

Registration Form Please Check: Boy Girl Age: Camper s Name: Address: City: State: Zip Code:

Registration Form Please Check: Boy Girl Age: Camper s Name: Address: City: State: Zip Code: Registration Form Please Check: Boy Girl Age: Camper s Name: Address: City: State: Zip Code: Contact Name: Emergency Contact Number: Alt. Emergency Contact Number: E-Mail Address: Alt. Contact Name: Check

More information