*** LUNCH WILL NOT BE PROVIDED. *** There will be some groups at the Y selling food for those interested, or you may bring your own.

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1 REGISTER AND PAY ONLINE! Dear Region #22 Dan and Cho Dan Bo Members, We would like to invite you to join us for the Region #22 Black Belt Clinic, to be held October 12, 2013 at the Hollidaysburg Area YMCA in Hollidaysburg, PA. Join us as we dedicate time to the quality of the Black Belts in our region. We hope that you will find that Camp will offer all attendees the opportunity to challenge themselves mentally and physically. We look forward to seeing all of you at the Clinic! WHEN: October 12, 2013 WHERE: Hollidaysburg Area YMCA 1111 Hewit Street, Hollidaysburg, PA COST: $45.00 Price includes: Training and a T-Shirt. Registration Deadline: September 13, 2013 *** LUNCH WILL NOT BE PROVIDED. *** There will be some groups at the Y selling food for those interested, or you may bring your own. REGISTER AND PAY ONLINE ARTICLES TO BRING: dobohk, protective gear, sneakers, rank appropriate training weapons** (staff, training knife, training sword, cane) and any other articles you think you may need. Sun Screen, healthy snacks, fruits and beverages are strongly encouraged. Live blades are not permitted for training purposes, please bring an appropriate dull trainer if you are required to know the dagger or sword forms. Sponsoring Studios A Mountain Wind Martial Arts Appalachia Tang Soo Do Buckeye Tang Soo Do Clearfield DJ Studios Columbus Tang Soo Do Academy DJ Studios Hidden Tiger Tang Soo Do Hollidaysburg YMCA Tang Soo Do Imperial Dragon Tang Soo Do In Neh Martial Arts Johnstown Tang Soo Do Josefik s Korean Tang Soo Do Keystone Martial Arts I, II Mountain Lair Tang Soo Do Penn State Martial Arts River Valley Tang Soo Do Acad. Rivers Edge Martial Arts Steel Dragon Martial Arts Summers Martial Arts I, II Tri County Tang Soo Do Tyrone Tang Soo Do Western PA Martial Arts Note regarding Youth versus Adult campers All students 13 and under will participate in the YOUTH breakout sessions. There will be NO EXCEPTIONS. While we appreciate that some students may find this unfair, we assure you that all students will be sufficiently challenged both mentally and physically. All Campers will train together for group drill, forms and other activities, while youth aged will be permitted to train alongside adults. In order to receive credit for the clinic, ALL students regardless of age will be expected to remain on the YMCA grounds for the duration of the event. REGISTER AND PAY ONLINE!

2 REGISTER AND PAY ONLINE! Region #22 Black Belt Clinic Registration Form Please type or print legibly ***** This application must be postmarked by September 13, ***** Name Assoc. # Address Studio Rank Date of Birth Phone # ( ) Gender Instructor s Signature (Instructor s approval signature is required) T-Shirt Size: Youth M Adult S M L XL XXL (Circle one) Address: Special Medical Conditions Please list all known medical conditions/information including but not limited to: allergies, injuries, medications. Primary: Emergency Contacts Phone # (w/area Code) Also at camp? Yes / No Alternate: Phone # (w/area Code) Send applications, with check or WTSDA Region 22 money order for $45.00 payable to: c/o Thomas Marker WTSDA Region Jonson Ct. Reynoldsburg, OH ASSUMPTION OF RESPONSIBILTIES AND RISK I, the undersigned, have read the attached Adult Camper Insurance and General Liability Information and fully understand and accept its contents. Student Signature Date Print Name PARENTAL INDEMNIFICATION (if under 18) As legal guardian for my child I assume all responsibility and risk, as detailed in the attached Youth Camper Insurance and General Liability Information. I have read and fully understand and accept its content. Parent/Legal Guardian Signature Date Print Name REGISTER AND PAY ONLINE!

3 Youth Camper - Insurance and General Liability Information By signing the 2013 Region 22 Annual Dan Camp form and allowing your child to attend the Region #22 Black Belt Camp, you hereby agree to the following: GENERAL RELEASE: I hereby agree for myself and/or my child (or children, as the case may be) and our respective heirs, assigns and legal representatives, to indemnify, defend and hold the (i) World Tang Soo Do Association (WTSDA) and its officers, directors, board members, employees, volunteers, agents, independent contractors, instructors, counselors, participating studios, regional director(s), (ii) other participants and (iii) the Hollidaysburg Area YMCA (collectively, the Staff) harmless from any and all claims and causes of action of any nature for any and all personal injury or illness, including, but not limited to death, which may occur to me and/or my child or which may be aggravated during or by any activity during the course of the program in which I have decided to allow myself and/or my child to engage. I further waive any and all claims or causes of action, which I and/or my child may now or hereafter have against the Staff which may at any time arise directly or indirectly related to my and/or my child s participation in the program. I further expressly understand and agree the foregoing indemnity, release and waiver is intended to be as broad and inclusive as permitted by the Laws of the Commonwealth of Pennsylvania and that if any portion thereof is held invalid, illegal or unenforceable, it is agreed that the balance shall, notwithstanding, continue in full force and effect. ASSUMPTION OF RISK: I, individually and/or on behalf of any minor child, expressly and specifically assume any and all risk of injury, illness, death or property damage resulting from my Tang Soo Do (TSD) activities. Further, I, individually and on behalf of my minor child, understand that TSD activities are strenuous and dangerous and should be engaged in only by persons in good health. I understand that I should consult a physician before enrolling myself and/or my child in the TSD program. I understand the risks involved and accept all of the risks. MEDICAL RELEASE: I, individually and/or on behalf of any minor child, further hereby release the Staff from any claim whatsoever which may arise as a result of any first aid, treatment or services or assistance provided to me in connection with any injury that arises from activities at Region 22 Dan Camp. I take full responsibility for my and my child(s) welfare and safety during TSD or TSD related activities. I hereby give permission for emergency medical treatment to be administered as deemed appropriate. INSURANCE: I understand that I am expected to have my own health insurance to cover me and my child. I understand that the WTSDA does not carry insurance to cover injuries and losses that may befall me and/or my child. I understand and agree that should medical attention be required, I and/or my insurance provider shall be responsible for all costs associated with such medical attention. PHOTOGRAPHIC RELEASE: I consent on behalf of myself and my minor child, to be photographed and to allow WTSDA to use any or all photos of myself and/or my minor child at its sole discretion. RULE ACKNOWLEDGEMENT: I understand that myself and my minor child are required to obey all rules and regulations governing this seminar and failure to do so may result in me and/or my child s expulsion from this seminar without a refund. Student Name Parent/Legal Guardian Signature Date Print Name

4 Adult Camper - Insurance and General Liability Information By signing the 2013 Region 22 Annual Dan Camp form and attending the Region #22 Black Belt Camp, you hereby agree to the following: GENERAL RELEASE: I hereby agree for myself, my respective heirs, assigns and legal representatives, to indemnify, defend and hold the (i) World Tang Soo Do Association (WTSDA) and its officers, directors, board members, employees, volunteers, agents, independent contractors, instructors, counselors, participating studios, regional director(s), (ii) other participants and (iii) the Hollidaysburg Area YMCA (collectively, the Staff) harmless from any and all claims and causes of action of any nature for any and all personal injury or illness, including, but not limited to death, which may occur to me or which may be aggravated during or by any activity during the course of the program in which I have decided to allow myself to engage. I further waive any and all claims or causes of action, which I may now or hereafter have against the Staff which may at any time arise directly or indirectly related to my participation in the program. I further expressly understand and agree the foregoing indemnity, release and waiver is intended to be as broad and inclusive as permitted by the Laws of the Commonwealth of Pennsylvania and that if any portion thereof is held invalid, illegal or unenforceable, it is agreed that the balance shall, notwithstanding, continue in full force and effect. ASSUMPTION OF RISK: I, individually expressly and specifically assume any and all risk of injury, illness, death or property damage resulting from my Tang Soo Do (TSD) activities. Further, I, individually understand that TSD activities are strenuous and dangerous and should be engaged in only by persons in good health. I understand that I should consult a physician before enrolling myself in the TSD program. I understand the risks involved and accept all of the risks. MEDICAL RELEASE: I, individually further hereby release the Staff from any claim whatsoever which may arise as a result of any first aid, treatment or services or assistance provided to me in connection with any injury that arises from activities at Region 22 Dan Camp. I take full responsibility for my welfare and safety during TSD or TSD related activities. I hereby give permission for emergency medical treatment to be administered as deemed appropriate. INSURANCE: I understand that I am expected to have my own health insurance to cover me. I understand that the WTSDA does not carry insurance to cover injuries and losses that may befall me. I understand and agree that should medical attention be required, I and/or my insurance provider shall be responsible for all costs associated with such medical attention. PHOTOGRAPHIC RELEASE: I consent on behalf of myself, to be photographed and to allow WTSDA to use any or all photos of myself at its sole discretion. RULE ACKNOWLEDGEMENT: I understand that I am required to obey all rules and regulations governing this seminar and failure to do so may result in me and/or my child s expulsion from this seminar without a refund. Student Signature Date Print Name

5 Preliminary Schedule 7:00 Registration Begins 8:00 Bow-In, Announcements 8:15 Cardio Warm-up 8:30 Hand and Kick Drill 9:00 One-Step Review and Study 10:00 Hyung by Rank 11:00 Weapon training by Rank 12:00 Lunch Break 1:00 Breakout Session #1 2:00 Breakout Session #2 3:00 Breakout Session #3 4:00 Group Training 5:00 Bow-out, closing Ceremonies 5:30 Dismissal and pickup While we are still confirming our breakout sessions, here is a sampling of previously offered topics to give you an idea of what to expect: Hyung Applications Dynamic Kicking Nunchaku Written Exam Prep. Stretching Tai Chi Flexible Weapons Hapkido Hand Trapping Sword 1-Steps Sparring Breaking Falling Self-defense skills Bong Dexterity