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

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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 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

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