Open Nationals. A.O.K. A Rated
|
|
- Emmeline Ball
- 5 years ago
- Views:
Transcription
1 Grandmaster Linda Denley & TBB Academy present The 40th annual SPACE CITY Open Nationals LINDA DENLEY April 14 HOUSTON The Texas Terror Rated #1 from time Battle of Atlanta WInner 3-time Diamond Nationals Winner 9-time U.S. Open Winner 4-time Long Beach Internationals 9-time Capitol Classics winner AOK Instructor of the Year 1999 AOK "True Living Legend 2002 A.O.K. A Rated Saturday April 14 Pre-register online by 4/11 to save All organizations, all Styles are welcome! Black Belt Grand Champion Expense Money Beautiful Awards for 1st, 2nd & 3rd Place in all Kata & Sparring Divisions No Competitor will leave without an Award Register: Humble Civic Center 8233 Will Clayton Pkwy, Humble, Texas AOK rules will be strictly enforced no groin kicks AOKSTRONG.COM
2 April 14, 2018 Doors Open 8:00am Black Belt/Competitors Rules Meeting 9:30am Competition immediately following SAVE TIME and MONEY AOKstrong.com/spacecity 40th Annual SPACE CITY Open Nationals Presented by GrandMaster Linda Denley A.O.K. A Rated Humble Civic Center 8233 Will Clayton Pkwy, Humble Pre-register ONLINE at Discounts available for online registrations ONLY If you are unable to register online, you may choose to complete paper registration at full price. Please fill out (PRINT) the entire form and sign waiver on the following page. Please confirm all your divisions and spectator tickets. Mail form with check or money order payable to: Linda Denley Veterans Memorial Dr. Ste. 11 Houston, Texas Must be received by April 11 WE ARE NOT RESPONSIBLE FOR LOST OR DELAYED MAIL **** SPACE CITY OPEN 2018 REGISTRATION INFORMATION **** Competitor Name: Age: D.O.B. / / Home Address: Phone: ( ) Weight: lbs. City: State: Zip: Gender: Male Female Belt Color: Beginner (White/Yellow/Gold/Orange) Dojo Name/City: Intermediate (Green/Purple/Blue) Dojo Address: Advanced (Brown /Red) Black Belt Instructor: Dojo Phone: Dojo EVENTS Division Codes Online Pre-Reg by 4/11 Mail In Registration TOTAL A.O.K. Divisions (up to 2 events) ( ) ( ) $55.00 $60.00 $ save ONLINE Each Additional AOK Division ( ) ( ) ( ) ( ) $10.00 x $15.00 x $ Spectator Pass (4 and under FREE) $13.00 x $15.00 x $ Ringside Spectator Pass $50.00 x $60.00 x $ Breaking Divisions (1st event) ( ) $30.00 $40.00 x $ Each Additional Breaking Division ( ) ( ) ( ) ( ) $20.00 x $20.00 x $ Boards (must pre-purchase for tournament consistency) $3.50 x $3.50 x $ All Entries Include System Management Fee $5.00 $5.00 $ 5.00 TOTAL AMOUNT ENCLOSED $ ***NO REFUNDS for ANY REASON NO CASH at the DOOR PLEASE DO NOT ASK*** Paying by credit card? REGISTER ONLINE & SAVE ONLINE Discounted Pre-Registration is available online until 4/11/18
3 RELEASE OF LIABILITY, ASSUMPTION OF RISK, AND PARENTAL CONSENT AND INDEMNITY AGREEMENT Space City Open (herein referred to as "EVENT" or "EVENTS"), Amateur Organization of Karate (herein referred to as "SANCTIONING AUTHORITY") In consideration of being permitted to participate in any way in the EVENT and associated classes, courses, and training or being permitted to enter for any purpose any restricted area (herein defined as any area wherein admittance to the general public is prohibited), the participant, parent(s), or legal guardian(s) of the participant agree: 1. I have read, understand, and agree to abide by the rules and regulations imposed by the EVENT and/or the SANCTIONING AUTHORITY and that failure to abide by the rules or conduct is not cooperative for the successful operation of the tournament as determined by any of the Releasees at their sole discretion, that I/WE may be dismissed from the premises without compensation, and MY/THE MINOR'S credentials may be taken away along with all rights and privileges provided by those credentials. The promoter(s) reserves the right to refuse entry to anyone. 2. That I/WE fully understand and acknowledge that the participant's medical conditions and hereby certify the participant is mentally and physically fit to participate in said EVENT. 3. That I/WE fully understand the nature and purpose of the EVENT and acknowledge the participant's experience and capabilities and believe the participant is qualified to participate in such EVENTS/Activities. 4. If I/WE fail to check-in onsite at the EVENT, I/WE knowingly forfeit all applicable registration fees. I/WE understand that refunds will not be given to domestic participants for any reason and that foreign participants must provide proof of denial of an entry visa to receive a refund less fees. 5. That I/WE understand that the EVENT will be conducted in facilities open to the public during the EVENT. 6. I/WE understand that MY/THE MINOR'S name, registration information, biographical information, likeness, any audio, pictures, photography, videography, media coverage, statements, interviews, and/or other visual and written mediums taken of ME/THE MINOR in connection with or at the EVENT may be used, in any form or language, by those directly associated with this EVENT, including sponsors, at any time for publicity, promotion, or media relations, and I do hereby waive any compensation in regard thereof as well as any future rights to the aforementioned. 7. I / WE fully understand and acknowledge that: (a) There are risks and dangers associated with participation in Martial Arts EVENTS and activities which could result in bodily injury, partial or total disability, paralysis and death. (b) The social and economic losses or damages, which could result from these risks and dangers described above, could be severe. (c) These risks and dangers may be caused by the action, inaction or negligence of the participant or the action, inaction or negligence of others, including, but not limited to, the Releasees named below. (d) There may be other risks not known to us or are not reasonably foreseeable at his time. 8. That prior to participating in the EVENT, I/WE will inspect the facilities and equipment to be used, and I/WE believe anything is unsafe, the I/ WE will immediately advise the officials of such condition and refuse to participate. I/WE understand and agree that, if at any time, I/WE feel anything to be UNSAFE, I/WE will immediately take all precautions to avoid the unsafe area and REFUSE TO PARTICIPATE further. 9. I / WE ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES incurred as a result of my participation, or that of the minor, however caused and whether caused in whole or in part by the negligence of the Releasees named below. 10. I / WE HEREBY RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE the EVENT, or any of its officers, administrators, directors, agents, members, volunteers, employees, other participants, officials, rescue personnel, sponsors, advertisers or any individual connected with the organization or promotion of the EVENT, the SANCTIONING AUTHORITY(s), or employees or any individual connected with execution of, or having a vested interest in the EVENT, the facility used by the participant, including its owners, managers, promoters, lessees of premises used to conduct the EVENT premises and EVENT inspectors, underwriters, consultants and others who give recommendations, directions, or instructions to engage in risk evaluation or loss control activities regarding the facility or EVENTS held at such facility and each of them, their directors, officers, agents, employees, all for the purposes herein referred to as "Releasee" FROM ALL LIABILITY TO THE PARTICIPANT, my/our personal representatives, assigns, executors, heirs and next to kin FOR ANY AND ALL CLAIMS, DEMANDS, LOSSES OR DAMAGES AND ANY CLAIMS OR DEMANDS THEREFORE ON ACCOUNT OF ANY INJURY, INCLUDING BUT NOT LIMITED TO THE DEATH OF THE PARTICIPANT OR DAMAGE TO PROPERTY, ARISING OUT OF OR RELATING TO THE EVENT(S) CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE RELEASEE OR OTHERWISE. I / WE also expressly acknowledge that INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE OPERATIONS OR PROCEDURES OF THE RELEASEES; 11. AND I FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, or anyone on my behalf, makes a claim against any of the Releasees, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expenses, attorney fees, loss, liability, damage, or cost which may be incurred as the result of such claim and will reimburse the Releasee for any money which they have paid to the participant, or on his behalf, and hold them harmless. 12. I / WE further expressly agrees that the foregoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as is permitted by the law of the Province, State, or Country in which the EVENT is conducted and that if any portion is held invalid, it is agreed that the balance shall, notwithstanding continue in full legal force and effect. I, (Print Name), THE UNDERSIGNED, ACKNOWLEDGE THAT I AM AGE 18 OR OLDER, HAVE THE LEGAL AUTHORITY TO SIGN FOR THE PARTICIPANT, HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID, THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT. I ACKNOWLEDGE NO REFUNDS CAN BE PROVIDED AND THAT DIVISION SWAPPING IS NOT ALLOWED. (Signature) Date:
4 A.O.K.STANDARD DIVISIONS Kata (Empty Hand Forms) Beg Intr Adv Black Handicapable * <= 17 H-1 Handicapable * 18+ H-2 Boys & Girls <= 5 F-1 Boys & Girls 6-7 F-2 F-3 F-4 Boys & Girls 8-9 F-5 F-6 F-7 Boys & Girls F-8 F-9 F-10 F-11 Boys & Girls F-12 F-13 F-14 F-15 Boys & Girls F-16 F-17 F-18 F-19 Boys & Girls F-20 F-21 F-22 F-23 Women 18+ F-24 F-25 F-26 F-30 Men 18+ F-27 F-28 F-29 F-32 Women 32+ F-31 Men 35+ F-33 Women 42+ F-34 Men 45+ F-35 Soft Style 18+ F-36 Traditional 18+ F-37 Traditional 35+ F-38 Traditional F-39 Specialty/Self-Defense Beg Intr Adv Black Boys & Girls <= 11 M-1 M-2 M-3 M-4 Boys & Girls M-5 M-6 M-7 M-8 Men & Women 18+ M-9 M-10 Men & Women 35+ M-11 Weapons 18+ M-12 Team Forms (All Ages) M-13 Self-Defense <= 17 M-14 M-15 Self-Defense 18+ M-16 M-17 Black Belt Expense Money Awards for 1st, 2nd & 3rd - ALL Kata & Sparring Medals for ALL Kata athletes <12yrs No athlete will leave without an AWARD Sparring - Point Beg Intr Adv Black Girls <= 5 S-1 Boys <= 5 S-2 Girls 6-7 S-3 S-4 S-5 Girls 8-9 S-6 S-7 S-8 Girls S-9 S-10 S-11 S-12 Girls S-13 S-14 S-15 S-16 Girls S-17 S-18 S-19 S-20 Girls S-21 S-22 S-23 S-24 Boys 6-7 S-25 S-26 S-27 Boys 8-9 S-28 S-29 S-30 Boys S-31 S-32 S-33 S-34 Boys S-35 S-36 S-37 S-38 Boys S-39 S-40 S-41 S-42 Boys S-43 S-44 S-45 S-46 Women 18+ (all wt) S-47 S-48 S-49 Women 32+ (all wt) S-50 S-51 S-52 Men 18+ (Lt<= 185) S-53 S-55 S-57 Men 18+ (Hvy>185) S-54 S-56 S-58 Men 35+ (all wt) S-59 S-60 S-61 BB Sparring - Point Fly <= 134 Light> 134 Women 18+ S-62 S-63 Women 32+ S-64 S-65 BB Sparring - Point Light <= 160 Middle <= 185 Heavy > 185 Men 18+ S-66 S-67 S-68 Men 35+ S-69 S-70 Men 45+ S-71 S-72 Men 55+ (all wt) S-73 EQUIPMENT REQUIREMENTS: A.O.K. RULES WILL BE STRICTLY ENFORCED Please review rules at Only AOK approved soft foam type sparring equipment and mouthpiece are mandatory in all Sparring Divisions (includes Fun Flag Sparring). Male and female competitors must wear groin protectors. Regulation Karate / Kung Fu uniforms must be worn with sleeves reaching elbows. Full uniforms must be worn for sparring. No sharp bladed and/or loose fitted weapons are allowed. Equipment may be available for purchase on the day of the event.
5 Brand new for 2018 at the SPACE CITY Open Nationals LARRY FIELDS SPECIALTY DIVISIONS Breaking Divisions (divisions may be combined) Power Wood Hand Foot Elbow Boys & Girls <= 5 (All Belts) BPWH-1 BPWF-1 BPWE-1 Boys & Girls 6-8 (All Belts) BPWH-2 BPWF-2 BPWE-2 Boys & Girls 9-12 (All Belts) BPWH-3 BPWF-3 BPWE-3 Boys & Girls Beg-Adv BPWH-4 BPWF-4 BPWE-4 Men Beg-Adv 18+ BPWH-5 BPWF-5 BPWE-5 Women Beg-Adv 18+ BPWH-6 BPWF-6 BPWE-6 Black Belt Boys BPWH-7 BPWF-7 BPWE-7 Black Belt Girls BPWH-8 BPWF-8 BPWE-8 Black Belt Men 18+ BPWH-9 BPWF-9 BPWE-9 Black Belt Women 18+ BPWH-10 BPWF-10 BPWE-10 SPACE CITY Open Nationals proudly presented by GrandMaster Linda Denley & TBB Academy For more information, contact Grand Master Denley (281) AOKstrong.com/spacecity sanctioned powered driven
SCCA Rally/Solo Release and Waiver Guidelines
RISK MANAGEMENT I. Introduction SCCA Rally/Solo Release and Waiver Guidelines These guidelines are intended to provide basic information regarding release and waiver procedures for ALL non-club or SCCA
More informationInstructions for Completing Ford DSFL Waivers
Instructions for Completing Ford DSFL Waivers 1) Print out the four (4) forms attached. (Print in color if possible) 2) All 4 forms must be filled in COMPLETELY. If forms are not completed and signed properly
More informationA.A.U. Region 9 Taekwondo Championship March 2, 2013 Butler Sports Complex South Main Houston, Texas INFORMATION SHEET
INFORMATION SHEET Competition Date: SATURDAY, MARCH 2, 2013 Entry Fees: 1 or 2 Individual Events $85.00 3 Events $100.00 CLINICS: Referee Clinic ONLY: $35.00 (coaches must take clinic online!) Friday,
More information2015 AAU/USA NATIONAL KARATE CHAMPIONSHIPS
2015 AAU/USA NATIONAL KARATE CHAMPIONSHIPS CLUB APPLICATION INSTRUCTIONS 1. Any AAU member club may send in a club application, instead of individual entry applications. 2. Please follow all instructions
More information2016 AAU/USA NATIONAL KARATE CHAMPIONSHIPS CLUB APPLICATION INSTRUCTIONS
2016 AAU/USA NATIONAL KARATE CHAMPIONSHIPS CLUB APPLICATION INSTRUCTIONS 1. Any AAU member club may send in a club application, instead of individual entry applications. 2. Please follow all instructions
More informationHAWAII JUDO ACADEMY Building Champions for Success at All Levels in Life
10AM 11AM CLASS SCHEDULE Monday Tuesday Wednesday Thursday Friday Saturday Training (Kids &Adult) 10:00-12:00) 12AM 1 PM 4PM Kids Intro 4:30-5:00 5 PM Kids Kids 1 5:00-7:00 5:00-6:10 6 PM Kids 2 6:15-7:25
More information2009 is the age they MUST compete at. If your athlete is 9 now but will be 10 in April, May, or June, they must compete in the 10 year old division.
MONTANA AAU KARATE DISTRICT CHAMPIONSHIPS 610 Professional Dr., Suite 1 Phone: (406) 994-9194 Tournament Date: Saturday, May 9, 2009 Location: Time: Bozeman Senior High School South Gymnasium 205 N. 11
More informationOBSERVED HOLIDAYS No classes
1 114 E Oak Ave Visalia, CA 93291 (559) 627-8277 spacpp@att.net www.spacdance.com @WeTrainDancers Student Enrollment form Please fill out for each student Student Name (First) (Last) Address (Town) (Zip)
More information2012 AAU SOUTHWEST DISTRICT QUALIFIER
INFORMATION SHEET Competition Date: SATURDAY, FEBRUARY 11, 2012 Entry Fees: 1 or 2 Individual Events $65.00 3 Events $75.00 CLINICS: Referee Clinic ONLY: $35.00 (coaches must take clinic online!) Friday,
More informationOgden Cycle Association Membership Agreement
Date: Ogden Cycle Association Membership Agreement Membership Type: (mark all that apply) Single Family Non-Wor king Charter Life Cash / Check # Amount Paid $ Receipt # New Member / Annual Renewal I agree
More informationWAIVER, RELEASE OF ALL LIABILITY AND ASSIGNMENT OF CLAIMS. As consideration for being allowed to participate in the event described below, I agree:
WAIVER, RELEASE OF ALL LIABILITY AND ASSIGNMENT OF CLAIMS As consideration for being allowed to participate in the event described below, I agree: 1. I acknowledge that motor vehicle activity is a potentially
More informationPRINTING INSTRUCTIONS
PRINTING INSTRUCTIONS All forms must be printed in COLOR on standard 8.5 x 11 paper. Black and white or illegible copies will NOT be accepted. 1. The MINOR VEST APPLICATION is a one (1) page form. 2. The
More informationPraise His Name in the Dance Psalm 149:3
Praise His Name in the Dance Psalm 149:3 Welcome to our studio! The mission of Winchester Christian Ballet, Inc. is to provide the highest quality of classical ballet training, create an atmosphere of
More informationRETAIN THIS SHEET FOR YOUR INFORMATION AND MAIL ENTRY FORM
REVISED 01/20/08 SIXTH ANNUAL AAU TRIPLE CROWN CLASSIC 2008AAU EAST COAST BENCH PRESS CLASSIC 2008 AAU MILITARY NATIONALS FULL POWER 2008 AAU MILITARY NATIONALS BENCH PRESS ENTRY DEADLINE: APRIL 20, 2008
More informationSUNDAY, MARCH 29, 2015
The Northern California Karate-do Federation Presents: QUALIFIER FOR 2015 USA KARATE NATIONALS AND TEAM TRIALS SUNDAY, MARCH 29, 2015 River Valley High School 801 El Margarita Yuba City Schedule of Events:
More informationALL DRIVERS MUST COMPLETE INFORMATION BELOW
Mailing Address: PO Box 322 Lancaster, NY 14086 Phone: 716-759-6818 Website: LancasterNationalSpeedway.com 2018 STOCK CAR REGISTRATION, MEMBERSHIP & NUMBER APPLICATION PLEASE PRINT LEGIBLY ALL DRIVERS
More informationTHE KANSAS INDOOR ROWING CHAMPIONSHIPS XXIX
THE KANSAS INDOOR ROWING CHAMPIONSHIPS XXIX Saturday February 26, 2011 Lyman Elementary School 2032 N. Kansas Ave. Topeka, Kansas 9:00AM to Noon! All races are Finals (with Flights as needed) Events for
More informationPOTOMAC VALLEY AAU REGISTRATION INFORMATION
POTOMAC VALLEY AAU REGISTRATION INFORMATION Please ensure ALL documents are completed as indicated and placed in a large 9x12 envelope. Note: Rules requiring Government issued ID are in effect. Do not
More informationU.S. GOLD GYMNASTICS & CHEER ACADEMY INC.
RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT ( AGREEMENT ) In consideration of participating in all activities at U.S. Gold Gymnastics and Cheer Academy, Inc., I represent
More informationIndividual Waiver. PUEBLO RANGERS, 5v5 or 3v3 SOCCER LEAGUE AND TOURNAMENT WAIVER AND RELEASE OF LIABILITY
PUEBLO RANGERS Individual Waiver Soccer Club PUEBLO RANGERS, 5v5 or 3v3 SOCCER LEAGUE AND TOURNAMENT WAIVER AND RELEASE OF LIABILITY (MUST BE COMPLETED AND PRESENTED AT LEAST 30 MINUTES PRIOR TO YOUR FIRST
More information22nd Annual Go Shibata Memorial & Brown Belt Championships Texas Judo Inc All Star Event
HOST: Judo Team DATE: LOCATION: SANCTION: WEIGH-IN: Physical Education Activity Building (PEAP) 632 Penberthy Road College Station, Texas 77843 USA Judo Sanction pending Weigh-in and Registration at the
More informationParticipant Information (Incomplete information will not be processed) Last Name First Name Male Female Date of Birth: / /
ENTRY FORM Sponsored by Denver Northside Table Tennis 1-Star Tournament Sanctioned by USATT with $ 300 in Cash and Prizes Saturday, March 24 th 2018 www.denvernorthsidett.com or 303-601-3415 Participant
More informationADULT COACHING APPLICATION
- MIAMI ROWING & WATERSPORTS CENTER, Inc. ADULT COACHING APPLICATION -MEMBER HRLY Private lessons where non-members and members can come and row in a one-on-one session tailored to your skill level and
More informationCAPITAL BADMINTON ACADEMY.
CAPITAL BADMINTON ACADEMY www.capitalbadmintonacademy.com ABOUT US Welcome to Capital Badminton Academy! We re a badminton academy based in DMV (DC, Maryland and Virginia) and we train domestic and regional
More informationMembership Registration Form
Today s Date: Leeward Judo Club Membership Registration Form Primary Dojo Location (Check box): Pearl City Waipahu Student Information: Name (First, MI, Last) Date of Birth Age Sex Male Female Address
More informationRegistration Form. Mother s/guardian Name: LAST FIRST INITIAL Address: Home Phone: City: State: Zip: Cell Phone:
Registration Form Name: Address: City: State: Zip: School: Grade: Grad Year: GPA: HT: WT: Cell Phone: Email: Size: Shirt: Pants: Helmet: Shoe: Jersey #: (List 3 numbers) Parent/Guardian Information Player
More informationGRB Rigging Approval Form
GRB Rigging Approval Form All rigging and/or hanging requests are only authorized for installation if this form has been countersigned and drawings have been approved by the George R. Brown Convention
More informationPocock Rowing Center
Pocock Rowing Center Office Use QB LGL XL S Code Membership Forms New Member Existing Member Former Member First Name: Last Name: Address: City: St: Zip: Email Address: Cell Phone ( ) Alt Phone: ( ) Gender:
More informationMIAMI ROWING & WATERSPORTS CENTER, INC Membership (6 pages) Application For:
MIAMI ROWING & WATERSPORTS CENTER, INC. 2017 Membership (6 pages) Application For: FAMILY MEMBERSHIP: Initiation Fee: $500.00 Monthly Dues: $110.00 Annual Due $1320.00 Equipment Fund Monthly Due $15.00
More informationParticipant Information (Incomplete information will not be processed) Last Name First Name Male Female Date of Birth: / /
2018 Denver NorthSide TTC FALL CLASSIC TOURNAMENT ENTRY FORM Sponsored by Denver Northside Table Tennis 1-Star Tournament Sanctioned by USATT with $500.00 in Cash and Trophies Saturday, October 13 th,
More informationEntry Form Idaho Regatta June 22-24, 2018
Entry Form Idaho Regatta June 22-24, 2018 For Info call: Louis Schindler (760) 831-2325 Email: louisschindler2@gmail.com Website: www.idahoregatta.org Driver Name First Address City State Zip Phone ( )
More informationUNITED STATES AUTO CLUB
UNITED STATES AUTO CLUB 2015.25 MIDGET FAMILY COMPETITION LICENSE APPLICATION FOR ANNUAL FAMILY MEMBERSHIP & AUTHORIZATION FOR PUBLICITY USEAGE ANNUAL RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK
More informationVolunteer Application
Memorial and Museum 62 Battleship Place Camden, New Jersey 08103 Volunteer Application Name: Address:. Telephone: Home ( ) Cell ( ) Email: Area(s) of Interest: Referred by: Please complete the attached
More informationUNITED STATES AUTO CLUB
UNITED STATES AUTO CLUB 2016.25 MIDGET FAMILY COMPETITION LICENSE APPLICATION FOR ANNUAL FAMILY MEMBERSHIP & AUTHORIZATION FOR PUBLICITY USEAGE ANNUAL RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK
More informationLake Washington Rowing Club
Lake Washington Rowing Club 2018 Junior Rowing Program Participant Information Form Participant Information (all fields must be filled out),, Last Name First Name Today s Date Mailing Address Birthdate
More information2003 AAU JUNIOR OLYMPIC GAMES DanceSport and Salsa ENTRY INSTRUCTIONS
2003 AAU JUNIOR OLYMPIC GAMES DanceSport and Salsa INDIVIDUAL ATHLETE ENTRY FORM ENTRY INSTRUCTIONS ENTRY DEADLINE: Received by Tuesday, July 1, 2003. Late entries will not be accepted. Guaranteed overnight
More information2019 Grip it and Rip it Deadlift Contest
2019 Grip it and Rip it Deadlift Contest Sanctioned by R.A.W. United Meet Director: Bill Beekley * beekley220@gmail.com * 813-362-1908 Venue: Stronglife Training Facility/ Crossfit Jaguar * Tampa, Florida
More informationRelease of Liability PLEASE DO NOT CHANGE OR ALTER THE WORDING ON THIS WAIVER WITHOUT PRIOR APPROVAL FROM USROWING.
Release of Liability IN CONSIDERATION of being given the opportunity to participate in any USRowing activity, including scheduled, supervised club activities, and registered regattas, during the policy
More informationInformation about membership -
MEMBERSHIP INFORMATION 2018 We are excited about ST. CROIX JOAD and the opportunities that will present themselves to youth archers ages 8-20. ST. CROIX JOAD is one of only a handful USA ARCHERY JOAD clubs
More informationBIG ROCK GYMNASTICS & DYNAMITE CHEER
BIG ROCK GYMNASTICS & DYNAMITE CHEER Registration Form Please Print Clearly PERSONAL INFORMATION: Mailing Address City St Zip Both Parents E-Mail Address: / Home Phone # Childs Cell # Childs Email Mothers
More information39th Annual BENCH STRICT CURL DEADLIFT APRIL 21, % Raw prior to weigh-ins. $30 for Adults; $15 for athletes 19 & under and Special Olympians.
39th Annual BENCH STRICT CURL DEADLIFT APRIL 21, 2018 MEET DIRECTOR: Jay Siegel engrave2@verizon.net SCHEDULE: All events take place at the BIGLER YMCA 61 Walker Rd. Bigler, PA 16825 Friday April 20, 2018
More information23rd Annual Go Shibata Memorial Texas Judo Inc. All Star Event
HOST: www.aggiejudo.com DATE: LOCATION: Physical Education Activity Building (PEAP) 632 Penberthy Road College Station, Texas 77843 SANCTION: USA Judo Sanction #19523 v1 8/7/18 WEIGH IN: Weigh in and Registration
More informationPlease note that there is no liability coverage for wrestling activities held at a home or residential dwelling
Insurance coverage 2017-18 Insurance Information At USA Wrestling, our top priorities are safety and security. That's why we make sure you're covered by General Liability, Accidental Medical Expense, and
More informationTo: 2011 Pro Motocross Credential Applicants
To: 2011 Pro Motocross Credential Applicants Welcome to AMA Pro Motocross Championship racing. Attached is the 2011 Season Credential Application packet for the Lucas Oil AMA Pro Motocross Championship,
More informationMiami Beach Rowing Club 2016 Summer Camp
Miami Beach Rowing Club s Head Coach Vladimir Matovic and his experienced staff are ready to challenge new and experienced rowers to reach their potential in both sweep and sculling. MBRC s rowing camp
More informationMetzlers Gymnastics Training Center NON-COMPETE TEAM REGISTRATION FORM Please Print Clearly
Metzlers Gymnastics Training Center NON-COMPETE TEAM REGISTRATION FORM Please Print Clearly Last Name: Parent s Name: Address: City: State: Zip Code: Home Phone: Cell Phone: E-mail address: Work Phone:
More informationWELCOME TO STANLY COUNTY GYMNASTICS!
WELCOME TO STANLY COUNTY GYMNASTICS! 1960 Post Rd. Albemarle, NC 28001 Phone: 704-983-2414 Email: stanlycountygymnastics@gmail.com Website: www.stanlycountygymnastics.wildapricot.org Stanly County Gymnastics,
More informationIt s ROAD-E-O time! STATE Landfill Equipment ROAD-E-O: JUNE 15, 2013 Location: Republic s Benson Valley Landfill, 2157 Highway 151, Frankfort, KY
It s ROAD-E-O time! The SWANA ROAD-E-O is designed to enhance employee morale, instill a competitive spirit, and encourage superior performance among the solid waste drivers and equipment operators at
More informationORDER SONS OF ITALY IN AMERICA LODGE 2662 ARTS & CRAFTS VENDOR CONTRACT/RELEASE
ORDER SONS OF ITALY IN AMERICA LODGE 2662 ARTS & CRAFTS VENDOR CONTRACT/RELEASE DATE: JUNE 22 & 23, 2019 OCTOBER 5 & 6, 2019 LOCATION: THE MARKET COMMONS TIME: JUNE SATURDAY 11 AM 8 PM / SUNDAY 11 PM 7
More information2017 Minor Crew Check-List
2017 Minor Crew Check-List Following you will find the necessary forms to complete your 2017 IMSA Membership/License application and Annual hard card application. This checklist is meant to assist you
More information2012 LWRC Dues and Storage Fees
2012 LWRC Dues and Storage Fees Annual Membership Dues Regular Membership - $710.00 ($648.40 plus 9.5% tax) Family Membership $1065.00 ($972.60 plus 9.5% tax) Staff Membership for coaches & coxswains.
More informationESO GIRLS FASTPITCH SOFTBALL 2017 PLAYER REGISTRATION
ESO GIRLS FASTPITCH SOFTBALL 2017 PLAYER REGISTRATION Player Information First Name: Last Name: Address: City, State, Zip: Home Phone: Email: Date Of Birth: School: Grade: Jersey Size: Age Division Select
More informationPromoters hosting USECF insured events must complete the included USECF event agreement and return to the USECF.
Dear Race Director, Thank you for your interest in using the USECF event coverage for your event. Enclosed you will find USECF insurance information for the 2017 year which can be used for gravel grinders,
More informationAthlete C hecklist. Step 1: Step 2: Step 3: Step 4: CONTACT INFORMATION:
Athlete C hecklist Step 1: Complete the ATHLETE REGISTRATION forms including: ATHLETE INFORMATION ATHLETE RELEASE & WAIVER OF LIABILITY & ACCIDENT AGREEMENT PAYMENT AGREEMENT Step 2: Return forms with
More informationUpper Natoma Rowing Club Junior Member Application (Please print clearly)
Upper Natoma Rowing Club Junior Member Application (Please print clearly) Name Birth Date Address City State Zip Code Phone Numbers (Home) Athlete (Cell) Athlete E-mail address School Graduation Year USRA
More informationIndividual waiver Form: Master form included, makes copies as needed. Athletes should sign only where indicated (at ATHELTE S SIGNATURE line).
POTOMAC VALLEY REGISTRATION CHECK LIST Please double check to make certain that the following documents have been completed as indicated: Rules requiring Government issued ID is in effect. Registration
More informationTerms and Conditions for 5aside.org
Terms and Conditions for 5aside.org For more information on any of the below, please contact info@5aside.org League and playing rules are available separately through our website. Definitions These definitions
More informationMEMBERSHIP CATEGORY (circle one) For current dues please refer to the website Membership page
Page 1 MEMBERSHIP REGISTRATION RAT ISLAND ROWING AND SCULLING CLUB NAME (print clearly): Date of birth: / / Home phone: ( ) - - Work/Cell: ( ) - - Email: Mailing address (city/ state) (Zip) Today s date:
More informationHoover High School Invitational Regatta Hoover Reservoir Westerville, Ohio Saturday, April 12, 2003 Hosted by Westerville Crew
Hoover High School Invitational Regatta Hoover Reservoir Westerville, Ohio Saturday, April 12, 2003 Hosted by Westerville Crew COURSE The racecourse is a 1500-meter course on Hoover Reservoir in Westerville,
More informationSt. Cloud Steelhead Rugby Club Registration Check List 2011 (SCRF01)
St. Cloud Steelhead Rugby Club Registration Check List 2011 (SCRF01) Please make checks payable to St. Cloud Rugby Steelhead Player Full Name: Shorts Size needed (circle one, shorts are men s sizes): Small
More information2016 5K Reindeer Run/Walk Team Registration
2016 5K Reindeer Run/Walk Team Registration Team Registration Forms and Waiver must be fully completed and received by December 2 nd in order to receive the $20/person group rate; Minimum of 3 people per
More informationSummit County 4-H Saddle Horse Fair Registration Return by June 1, of current year
Summit County 4-H Saddle Horse Fair Registration Return by June 1, of current year Information Page Club Name: Exhibitor Name: DOB: 4-H Age (as of Jan 1) How many years in 4-H (including this year)? Parent/Guardian
More informationSouth Suburban Youth Rugby Club
South Suburban Youth Rugby Club Middle School Grades 4-8 High School Fresh-Soph & Varsity Registration for 2016 Spring Season ALL FORMS MUST BE COMPLETED AND TURNED IN AND DUES PAID IN FULL BEFORE A PLAYER
More informationTrans Am/SCCA Pro Racing Competition License and Annual Credential Application
Applicant Information: Trans Am/SCCA Pro Racing Competition License and Annual Credential Application Name: Birthdate: Phone: Address: SCCA Member #: City: State: Zip: E-mail Address: Emergency Contact:
More informationBurnouts Blown Open: Powerskids Cruise the Track. Entrant Name: Postal Address: Address: Mobile Number: Phone: (W/H) AASA License:
All Entrants MUST provide a clear external (front-on) photograph of their vehicle, as spots are limited. West Coast Nats reserves the right to refuse entry to any vehicle as Entrant numbers are capped
More informationCheer Tumbling Registration Form. (Please complete all fields and understand all information stated below) Student Information
Signature of Parent/or Legal Guardian Cheer Tumbling Registration Form (Please complete all fields and understand all information stated below) How did you hear about us? Referral Name: Student Information
More information2013 USACA MEMBERSHIP & INSURANCE
2013 USACA MEMBERSHIP & INSURANCE USACA Membership and Insurance Dues for 2013 Membership and Insurance rates for 2013 will remain the same as 2012 rates Membership and Insurance (general liability and
More informationDance-Dance/Drill Team
Dance-Dance/Drill Team Photocopy form as necessary. The signed Athlete Waiver must be submitted with this form. INSTRUCTIONS ENTRY DEADLINE: SEND: Received by Tuesday, July 1, 2003. Late entries will not
More informationLower Island Fire Departments. Fire Truck Pull Challenge for Muscular Dystrophy. June 18, 2016, 10am to 1pm TEAM KIT
Lower Island Fire Departments Fire Truck Pull Challenge for Muscular Dystrophy June 18, 2016, 10am to 1pm TEAM KIT Are YOU stronger than a FIREFIGHTER? Lower Island Fire Departments Dear Participants:
More information2018 INEX MEMBERSHIP APPLICATION
2018 INEX MEMBERSHIP APPLICATION ONE FORM PER APPLICANT THE ACCEPTANCE OF THIS APPLICATION AND FEE BY INEX DOES NOT CONSTITUTE MEMBERSHIP APPROVAL. INEX MAY DENY MEMBERSHIP TO ANY APPLICANT FOR ANY REASON.
More informationATHENS YMCA CAMP KELLEY SUMMER CAMP 2018
ATHENS YMCA CAMP KELLEY SUMMER CAMP 2018 POLICIES Cost: Full Week (5 Days) $115, Half Week (3 Days) $70; Additional Children: Any additional children will receive a $10 discount on full weeks ONLY. Registration
More informationKaren McCallum. Volunteer- Counselor in Training Applications. Spring Dear Counselor in Training Applicant:
Volunteer- Counselor in Training Applications Spring 2018 Dear Counselor in Training Applicant: Boardman Park Adventure Day Camp Program prides itself on its reputation for quality and service. This recognition
More informationChamber Bed Race Rules & Release of Liability/Registration Form
Chamber Bed Race Rules & Release of Liability/Registration Form Bed Design Beds must measure at least 3 feet wide by 6 feet long, but no more than 6 feet wide by 8 feet long handles included. (This means
More information*AHSEP reserves the right, at its sole discretion, to reject any candidate who does not meet the eligibility requirements as stated herein.
AHSEP Enrollment Information Hobie Wave 14 Sailing Classes Youth: Thursdays July 27 & August 3 5:30 8:30 Adults: Saturdays July 29 & August 12 1:30-4:30 The 2017 Hobie Wave 14 Sailing Classes will be a
More information2018 Youth Academy Parent/ Guardian Agreement with NUS s Continuing Education
2018 Youth Academy Parent/ Guardian Agreement with NUS s Continuing Education Welcome to NSU Youth Academy! We are excited to have your child with us. In order to provide the best experience for our students
More informationBlue Chip BOTT Event Agreement and Waiver
Blue Chip BOTT Event Agreement and Waiver BLUE CHIP AGREEMENT AND LIABILITY WAIVER (this "Agreement and Waiver") PLEASE READ THE FOLLOWING AGREEMENT CAREFULLY, AS IT AFFECTS YOUR FUTURE LEGAL RIGHTS. BY
More informationMembership Application
Membership Application 2018 2019 PLEASE USE A SEPARATE FORM FOR EACH MEMBER All fields must be completed and all required signatures must be included before application will be processed All fields must
More informationTEAM CONTACT: CONTACT PHONE: (Cell) (Home) ADDRESS: MAILING ADDRESS: CITY: STATE: ZIP:
SOUTH GEORGIA BBQ & OUTDOOR FESTIVAL 5 TH ANNUAL DOUGLAS BBQ COOK-OFF 2018 APPLICATION The team s Pit Master has to be a Georgia BBQ Association members, prior to competition. GBA individual membership
More informationproudly present: Saturday, August 6
proudly present: Saturday, August 6 RULES OF PERFORMANCE SQUAT: The lifter shall face the front of the platform. The bar shall be held horizontally across the shoulders, hands and fingers gripping the
More informationLooking for the Best Day Camp in South Florida? Look no further! CORAL REEF SPORTS CAMP Day Camp
Looking for the Best Day Camp in South Florida? Look no further! CORAL REEF SPORTS CAMP 2016-2017 Day Camp Contents Here s To A Great Winter! Theme Weeks Program Fees/Camp Details & Check In and Out Procedures
More informationD.M.G. Athletics. The Official Indoor/Outdoor Summer Basketball League. Team Registration Packet
D.M.G. Athletics Presents The Official Indoor/Outdoor Summer Basketball League Team Registration Packet Questions: Contact Coach Dawne Gittens at 860-929-7692 or via email at dgittens@bgchartford.org Team
More informationproudly present: Saturday, March 29
proudly present: Saturday, March 29 RULES OF PERFORMANCE SQUAT: The lifter shall face the front of the platform. The bar shall be held horizontally across the shoulders, hands and fingers gripping the
More informationAcademy of Ice Carving
2014 Registration Reservation Packet Weekday Month Date Note: To prepare for each day of instruction, you will also be provided 3-5 hours of essential drawing (and clay sculpting) activities to practice
More informationCamper Information Camper Name: Age: DOB: Address: City: State: Zip: Parent Information Parent/Guardian Name: Home Phone: Cell: Parent s
9744 St. Vincent Ave. Shreveport, La. 71106 Summer Day Camp 2018 Registration Packet We are delighted you have chosen to consider our fun camps this summer! We are looking forward to another great and
More informationTEAM KIT. Fire Truck Pull for Muscular Dystrophy Canada. Mission Fire/Rescue Service. September 12, am to 2pm
Fire Truck Pull for Muscular Dystrophy Canada September 12, 2015 10am to 2pm TEAM KIT Are your MUSCLES strong enough to pull a Fire Truck? Dear Participants: Mission Firefighters Charitable Society is
More informationWELCOME TO KITTY HAWK KITES The Largest Hang Gliding School in the World - Where the Adventure Begins *please print clearly and fill out completely
WELCOME TO KITTY HAWK KITES The Largest Hang Gliding School in the World - Where the Adventure Begins *please print clearly and fill out completely 1. Name: First Last M.I. 2. Email: 2. Mailing Address:
More informationDelray Beach Holiday Parade 2016 Vendor Application
Delray Beach Holiday Parade 2016 Application December 10, 2016 Rock and Roll Holiday December 10, 2016 The is one of Delray s longest running community events. It is free to the public, and attracts thousands
More informationPresents the Prairie Days Parade
Presents the Prairie Days Parade Saturday June 23, 2018 @ 9:30am Line up by 8:00am ~ Judging @ 9:00am Theme: Mail application to: Yelm Area Chamber of Commerce, PO Box 444, Yelm, WA 98597 or email to info@yelmchamber.com----application
More information2017 Haunted Halloween Race
2017 Haunted Halloween Race October 28, 2017 5:30pm 7:00pm (1.5 hour meet at regular speed session time) Hosted by: Core Speedskaters INFORMATION You must be a member of Northern California Speedskating
More informationDEPARTMENT G OPEN SWINE JACKPOT SHOW
DEPARTMENT G OPEN SWINE JACKPOT SHOW Superintendent Kurtis Kolb (309) 212-1813 Asst. Superintendents Mitch Wilson (815) 488-2007, Larry Kolb (309) 242-3367, Barry Stutzman (815) 867-2010 & Ryan Nenne (815)
More informationAgreement and Release of Liability
Agreement and Release of Liability MARTIAL ARTS TRAINING / WRESTLING AND FITNESS TRAINING ARE INHERENTLY DANGEROUS AND PHYSICALLY DEMANDING. IF YOU HAVE EXISTING MEDICAL CONDITIONS, BACK PROBLEMS, A HEART
More informationFlorida Waiver (Commercial) (All parents of minors who are Florida residents must sign both the Florida commercial and non-commercial waivers)
Florida Waiver (Commercial) (All parents of minors who are Florida residents must sign both the Florida commercial and non-commercial waivers) (Commercial Activity Providers) WAIVER AND RELEASE OF LIABILITY
More informationFirst Name: Middle Initial: Last Name: Gender: D.O.B: / / Age: Years of YMCA Camp Participation: Address: Apt/Unit #:
Camp Location: Camper Grade 2017-18 School Year: Does your camper require any special needs identified through Section 504 (I.D.E.A or an I.E.P)? Yes No If yes, please explain: Camper Grade 2018-19 School
More information2019 SUMMER DAY CAMP REGISTRATION
2019 SUMMER DAY CAMP REGISTRATION Child: First Name MI Last Name [ ] YMCA Member [ ] Non Member Email Enrollment Date SUMMER DAY CAMPS CHOOSE YOUR CAMPS & LOCATION: [ ] Ages 5-12 (must have attended kindergarten)
More informationHoney Bee Pageant Application
Honey Bee Pageant Application Applications need to be returned to North Logan City Office, 2076 N 1200 E, or emailed to northloganrec@gmail.com, by March 27, 2017 by 5 pm. (No late applications will be
More informationWisconsin U19-U17 Select Rugby 2010 Information
2010 Information www.wisconsinrugbyselects.com General Information: The Wisconsin Rugby Football Union is seeking U19 & U17 select level players to represent Wisconsin Union in the Rocky Mountain U19 &
More informationThe 2018 Rhode Island NFAA Sanctioned 300 Round NFAA State Championship
The Rhode Island Field Archery Association is proud to present : The 2018 Rhode Island NFAA Sanctioned 300 Round NFAA State Championship Hosted By: Tangy s Archery --Youth Form-- Style Division Target
More informationLEAGUE OF AMERICAN BICYCLISTS REQUEST FOR CERTIFICATE OF INSURANCE
LEAGUE OF AMERICAN BICYCLISTS REQUEST FOR CERTIFICATE OF INSURANCE (this form is only utilized when it is a requirement of the Third Party) NAME OF CLUB: DATE OF REQUEST: DATE CERTIFICATE NEEDED BY: NAME
More informationStructural Rigging Information
Structural Rigging Information General Information Freeman Audio Visual is the exclusive structural rigging contractor for the George R. Brown Convention Center. During the initial design stages, please
More informationNew Member Renewing Member Transferring previous club name
Membership Application 2017-2018 PLEASE USE A SEPARATE FORM FOR EACH MEMBER. Applications are due back in the office when you sign up for ice. *An asterisk indicates a field that is required in order to
More information