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 ____

 

 

Address_________________________________City_______________State_______ Zip________

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