Karate Kids In America
(Shorinkan San Diego)
Mail
Pre-Registration to: KKIA
(Pre-Registration ) 1205 N Melrose Dr #A
Vista CA, 92083
Name__________________________________
Age_____ Rank_______ Male____ Female
____
Name__________________________________
Age_____ Rank_______ Male____ Female
____
Name__________________________________
Age_____ Rank_______ Male____ Female
____
Name__________________________________ Age_____ Rank_______ Male____ Female ____
Style___________________________________
Karate School _____________________________
Instructor_______________________________
Phone____________________________________
Email________________________________________
(if you
want email contact)
Registration Fees
Pre-Registration (look at flyer for charges) Total:_______
Day of event (look at flyer for charges) Total:_______
Spectators (look at flyer for
charges) Total:_______
Grand Total:_______
Hold Harmless Waiver
and Release
I understand that
karate is a contact sport. As such, I am
aware that I am participating in an activity that involves physical contact and
injuries may occur, which may potentially involve great bodily harm or even
death and I do so at my own risk. I
waive any claim or cause of action I may have against the promoters of the
event, the judges, and other competitors, Shorinkan,
KKIA, Cirincione Inc, Boys and Girls Club of Vista,
Salvatore, Gricelda any other affiliated in
instructor or entities. I further agree to indemnify and hold harmless the
promoters, judges, Shorinkan, KKIA, Cirincione Inc, Boys and Girls Club of Vista, Salvatore, Gricelda any other affiliated in instructor or entities
from any and all causes of action or claims which may arise from another
competitor due to my participation or actions in this event. I state that I do
not suffer from any physical and mental conditions, which may affect my
participation in this event. I further
agree to conduct myself in a sportsmanlike manner and understand that if I fail
to do so, I may be ask to leave from the event and not entitled to a refund.
______________________________________________________ __________________________
Signature of
competitor (Parent of Guardian if competitor is under 18) Date