Sponsered by Seattle Kyokushin
(all entry fees are non-refundable)
Please print out this page and mail application, check or money order payable in USD to:
Karate Kyokushin
Mailing Address:
Karate Kyokushin
Student Center, 350
901 12th Avenue,
P.O. Box 222000
Seattle, WA 98122-1090
Gender: __Male __Female Age/DOB: ____/____ Weight: ____
Rank: ___________ Yrs. Experience: ____
Style: ___________ Instructor/School: __________/__________
Entry Fee: __$30 __$25 (if received by April 1st, 2006)
Name: _______________________________________
Address: _____________________________________________
_____________________________________________________
City/State/Zip: _________________________________________
Phone: ______________________________
Email Address: _______________________ (you will receive confirmation via email)
Conditions of Registration:
I, the undersigned, do hereby
voluntarily submit my application for participation as a competitor in the
Kyokushin Challenge on April 29th, 2006 in Seattle, WA and do hereby
assume full responsibility for any and all damages, injuries or losses,
including death that I may sustain or incur while attending or participating in
the aforementioned event and do hereby waive any or all claims against Seattle
Kyokushin, its promoters, operators and/or sponsors of said event, their
employees and agents, individually or otherwise, and specifically covenant not
to bring suit to the individuals or organizations mentioned above, fully recognizing
that this covenant is part consideration for my approval to compete, and upon
which they have relied in accepting the above application. I further understand and am fully aware
of the inherent risks of sustaining injury during the competition or in the
preparation thereof and that I completely assume all risks and liabilities
thereto. I fully understand that
any medical treatment provided to me as a response to injury will be of the
first aid type only. I also fully
understand that I am solely responsible for payment of any additional medical
services performed as a result of my injury.
x___________________________________ Date: ___/___/_____
Applicants Signature
x___________________________________ Date: ___/___/_____
Parent or Guardian (if under 18 years of age)