Contact Shihan David Ames (330) 867-0100 email
or Shihan Larry Feldman (440) 248-6010 email

Karate, Kobudo, Ju-Jitsu, Chanbara

Lakeland Community College - Athletic & Fitness Center
7700 Clocktower Drive, Kirtland, Ohio 44894
Registration: 8:00 AM Competition: 9:30 AM
A message may also be left for Shihan Feldman at Lakeland CC by dialing (440) 953-7001 enter 2 then 4933

Entry Form ---- Division List

"The ultimate aim of karate do lies not in victory or defeat but,
in the perfection of the character of its participants"
-Ginchin Funakoshi, Founder of Shotokan Karatedo

Registration Instructions
1. The application must be completed and signed by you and /or parent
2. USAKF or Kwanmukan MEMBERSHIP IS NOT REQUIRED, but discounts are available for CURRENT MEMBERS OF USAKF OR Kwanmuzendokai International


Pre-registration is requested by October 4. 2003. A $5 late fee will be charged at the door for anyone desiring to register late. Current members of USAKF or KMK (with proof) will receive a $5 discount

Make checks/money orders payable to: Cleveland Kwanmukan Academy or CKA 33132 Springside Lane, Solon, OH 44139
Doors open at 8:00 AM. The competition will begin at 9:30 with Kobudo (weapons.)

*These events will be determined by the number entered by the day of competition - NO LATE FEE

Spectators: Adults $6 Children (4-12) $4 Senior Citizens $5

SAFETY EQUIPMENT: Mandatory mouth guard hand pads hard cup (males) Allowed - shin-insteps, arm pads, hard cups (male) Headgear allowed for youths, only


.

NOTE: Junior Divisions will depend on age and years of training of those who enter, divisions may be combined.

Weight divisions for ADULT ADVANCED will depend on weights of entered athletes. There will be an open-weight division also. Senior Division will be separate if enough enter. Adult Advanced Kata will be both OPEN and WUKO (two division)


Directions

Divisions: (check all that apply)
Jujitsu DUO Free Kata WUKO Kata Weapons
Kumite Open Weight Chanbara Team
Register now for pre-registration discount
Do you hold a 2003 membership in USAKF or KWANMUKAN International? Yes - No -

Name:_______________________________________________________________
Address: __________________________________________________City:________________________________
State ______Zip ______ E-mail: ____________________________________________________________________
Phone(_________) ___________________________
Age______ Sex______ DOB:______ State Zip ______ E-mail
Instructor: ____________________________________________________________________
School (DOJO) ____________________________________________________________________

PLEASE CHECK WHERE APPROPRIATE: (as of October 4, 2003)

A. Senior (Age 35 or over) Adult (over 18) Junior Athletes (Ages 6-18)
B. Sex: Male Female Weight
C. Time in Training: 0-1 years 1-2 years - 2-3 years 3-4 years over 4

LIABILITY WAIVER
I HEREBY FOR MYSELF, my executors), my heirs, my family, forever and always agree to save and hold harmless the Lakeland Community College, the Lakeland Community College Karate Club, CKA, USA Karate of Ohio, The USA Karate Federation, The Kwanmukan, and the members, employees, volunteers, officials, representatives, etc., of the aforenamed, and anyone else for and and/or all liability training for participating in, or competing in the said championships or for other direct or indirect involvement in said championships. In addition, I hereby and now and forever accept any and all responsibility for any and all of my actions in conjunction with said tournament and I further agree not to hold any of the aforementioned responsible for any and/or all of my actions. I further certify that I am physically fit to compete and that I know of no medical or psychological problem to prevent my participation. The undersigned have read the above waiver and release, understand that they have given up substantial rights by signing it and sign it voluntarily.

Signature: ____________________________________________________________________
Date: ___________________________

Parent/Guardian (If under 21): ___________________________________________

Date: ___________________________

No one may sign for a minor unless a parent or a legal guardian