Name:

Sex:

Date of Birth:

Citizenshiip:

Address:

City:

State:

Zip Code:

Country:

Phone (s):

Fax::

Email:

Date Training Began:

Rank:

Style:

Club or Organization:

Instructor

Signatures:

Personal:

Parent/Guardian if under Legal Age

Registration Date:

Amount of $28.50 Due and please pay by check, draft, or money order.

Please complete and following waiver - choose the first for adults or the second for minors.
Amateur Athletic Adult Waiver and Release of Liability

In consideration of being allowed to participate in any way in Kobudokan/The USA Karate Federation athletics/sports program, and related events and activities, the undersigned:

1. Agree that prior to participating, they will inspect the facilities and equipment to be used, and if they believe anything is unsafe, they will immediately advise their coach or supervisor or Kobudokan/USA Karate personnel of such condition(s) and refuse to participate.

2. Acknowledge and fully understaand that each participant will be engaging in activities that involve risk of serious injury, including permanent disability and death, and severe social and economic losses which might result not only from their own actions, inactions or negigence but the actions, inactions or negligence of others, the rules of play, or the condition of the premises or of any equipment used. Further, that there may be other risks not known to us or not reasonably foreseeable at this time.

3. Assume all the foregoing risks and accept personal responsibility for thednamages following such injury, permanent disability or deaty.

4. Release, waive, discharge and covenant not to sue Kobudokan/The USA Karate Federation, its affiliated clubs, regional sports organizations, their respective administrators, directors, agents, coaches, and other employees of the organization, other participants, sponsoring agencies, sponsors, advertizers, and, if applicable, owners and leasers of premises used to conduct the event, all of which are hereinafter referred to as "releasees" from any and all liability to each of the undersigned, his or her heirs and next of kin for any and all claims, demands, losses or damages on account of injury including death or damage to property, caused or alleged to be caused in hole or in part by the negligence of the releasee or otherwise,

The undersigned have read the above waiver and release, understand that they have given up substantial rights by signing it and sign it voluntarily.

Printed Name:_________________________________________ Contestants Signature __________________________________ Date __/__/__

Parent/guardian Signature ________________________________ Date __/__/__

Parent/guardian must sign if contestant is under the age of 19.

****************************************** Use following form for Minors **************************************

Amateur Athletic Waiver for MINORS and Release of Liability

In consideration of being allowed to participate in any way in Kwanmukan/Yamanka Kojute Jujitsu/ or The USA Karate Federation athletics/sports program, and related events and activities, the undersigned:

1. Agree that the parent(s) or legal guardian(s) will instruct the minor participant that prior to participating, he or she should inspect the facilities and equipment to be used, and if the participant believes anything is unsafe, he or she will immediately advise his or her coach or supervisor of such condition(s) and refuse to participate.

2. Acknowledge and fully understaand that each participant will be engaging in activities that involve risk of serious injury, including permanent disability and death, and severe social and economic losses which might result not only from their own actions, inactions or negigence but the actions, inactions or negligence of others, the rules of play, or the condition of the premises or of any equipment used. Further, that there may be other risks not known to us or not reasonably foreseeable at this time.

3. Assume all the foregoing risks and accept personal responsibility for the damages following such injury, permanent disability or death.

4. Release, waive, discharge and covenant not to sue Kwanmukan/Yamanka Kojute Jujitsu/ or The USA Karate Federation, its affiliated clubs, regional sports organizations, their respective administrators, directors, agents, coaches, and other employees of the organization, other participants, sponsoring agencies, sponsors, advertizers, and, if applicable, owners and leasers of premises used to conduct the event, all of which are hereinafter referred to as "releasees" from any and all liability to each of the undersigned, his or her heirs and next of kin for any and all claims, demands, losses or damages on account of injury including death or damage to property, caused or alleged to be caused in hole or in part by the negligence of the releasee or otherwise,

The undersigned have read the above waiver and release, understand that they have given up substantial rights by signing it and sign it voluntarily.

Parent or Guardian Signature ___________________________________________________ (Signature/Relationship) Date ____/____/____

Parent or Guardian Signature ___________________________________________________ (Signature/Relationship) Date ____/____/____

Printed Name of Parent or Guardian:______________________________________________

Printed Name Of Participant:__________________________________________________________________________________________

Address of Participant:_______________________________________________________________________________________________

Institution/Organization:____________________________________________________________