SUNDAY, MARCH 29, 2015

Transcription

1 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: Doors Open 8am Registration 8am Staging begins 8:45am Competition begins 9:30am Competition mats for all rings Licensed referees & judges Fully trained tournament staff Registration due before March 20, 2015 For more information: Miladi Karate Academy 950 Tharp Rd, Suite 1200 Yuba City, CA Custom medals USAK rules

2 For Our Out of Town Guests The following are also local motels available near the venue: Bonanza Inn: 1001 Clark Avenue, Yuba City, CA (530) $70-90/1-4 persons. Rate does not include tax. Dining room and coffee shop located in hotel. Hotel amenities include: outdoor pool & spa. Best Western 894 Onstott Frontage Rd., Yuba City, CA (530) $ Rate does not include tax. Hotel amenities include: outdoor pool, sauna and exercise gym. Travelodge 965 Gray Ave., Yuba City, CA $70-$80 Rate does not include tax. Hotel amenities include: outdoor pool. Directions To Yuba City from the Bay Area: - Interstate 80 East to Reno (to south Sacramento) - Interstate 5 North to Redding - Please refer to your area map for directions to your particular destination. To River Valley High School from the Bay Area: - Interstate 80 East to Reno (to south Sacramento) - Interstate 5 North to Redding - LEFT; on to Bridge St. - RIGHT; on to Walton Ave. - LEFT; on to Lassen Way - RIGHT; on to Harter Rd. - LEFT; on to Spirit, the gym is on the left From Sacramento International Airport: - Interstate 5 to Sacramento - Please refer to directions above to your particular destination.

3 801 El Margarita Rd, Yuba City, CA COMPETITION REGISTRATION FORM Age Male Female Beginner Novice Intermediate Advanced Division #Entered in: Kata Kumite Kobudo Check payable to: NCKF c/o Miladi Karate Academy 950 Tharp Rd, St One Division $50.00 Yuba City, CA Two Divisions $55.00 Three Divisions $60.00 TOTAL FEES PAID Pre-registration must be received by March 20, 2015 There will be a $15.00 charge for at the door registration. Name Birthdate Address City, State, Zip Phone Years Training Belt Color Kyu/Dan Style Intructors Name Dojo Name Dojo Address In consideration of being allowed to participate in any way in the Northern California Karate-Do Federation, Inc. qualifier, and related events and activities, the undersigned: 1. Agrees that prior to participating, they (if under 18 Parent or Guardian), will inspect the facilities and equipment to be used, and if the participant and/or Parent/ Guardian, believes anything is unsafe, they will immediately advise their coach or supervisor or Northern California Karate-Do Federation, Inc. personnel of such condition(s) and refuse to participate. disability and death, and severe social and economic losses which might result not only from their own actions, inactions or negligence but the actions, inactions or negligence of others, the rules of play, or the condition of the premises or of any equipment used. Further, that there may be other risks not known to us or not reasonably foreseeable at this time. 4. Releases, waives, discharges and covenants not to sue Northern California Karate-Do Federation, Inc., Jacobs Jr. High School, its officers, its affiliated clubs, regional sports organizations, their respective administrators, directors, agents, coaches and other employees of the organization, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessees of premises used to conduct the event, all of which are hereinafter referred to as releasees from any and all liability to each of the undersigned, his or her heirs and next of kin for any and all claims, demands, losses or damages on account of injury including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the releasee or otherwise. 5. All entries are final, no refunds will be given. I fully understand that any medical treatment given will be of a first aid treatment type only. I consent that any pictures furnished by me or any pictures taken of me in connection with the Tournament can be used for publicity, promotion or television showing now or in the future, and I waive compensation in regard thereto. All participation in any event or class in this Tournament is by permission only. The Director or his authorized agent(s) reserve the right to refuse entry to any person, school, team or club. 6. Understands that the tournament directors reserve the right to combine or cancel any division, or place any individual competitor in a different division in accordance with their size, age, or experience level. 7. Statement of Health. By my signature below I confirm that I am in sound health and there is no reason why I cannot participate in this championship and/or event. The undersigned have read the above waiver and release, understand that they have given up substantial rights by signing it and sign voluntarily. Date Signature of Contestant (If under 18 signature of Parent/Guardian)

4 801 El Margarita Rd, Yuba City, CA Kata Team Competition Registration One Team Entry $45 10&under &up Team Name: Instructor s Name: Dojo Name: Dojo Address Total Fees Paid. Make checks payable to: NCKF 950 Tharp Rd, Ste. 1200, Yuba City, CA (530) Pre-registrations must be received by March 20, 2015 $15 charge for at the door registrations 1. Name Birth Date 2. Name Birth Date 3. Name Birth Date In consideration of being allowed to participate in any way in the Northern California Karate-Do Federation, Inc. qualifier, and related events and activities, the undersigned: 1. Agrees that prior to participating, they (if under 18 Parent or Guardian), will inspect the facilities and equipment to be used, and if the participant and/or Parent/ Guardian, believes anything is unsafe, they will immediately advise their coach or supervisor or Northern California Karate-Do Federation, Inc. personnel of such condition(s) and refuse to participate. disability and death, and severe social and economic losses which might result not only from their own actions, inactions or negligence but the actions, inactions or negligence of others, the rules of play, or the condition of the premises or of any equipment used. Further, that there may be other risks not known to us or not reasonably foreseeable at this time. 4. Releases, waives, discharges and covenants not to sue Northern California Karate-Do Federation, Inc., Jacobs Jr. High School, its officers, its affiliated clubs, regional sports organizations, their respective administrators, directors, agents, coaches and other employees of the organization, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessees of premises used to conduct the event, all of which are hereinafter referred to as releasees from any and all liability to each of the undersigned, his or her heirs and next of kin for any and all claims, demands, losses or damages on account of injury including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the releasee or otherwise. 5. All entries are final, no refunds will be given. I fully understand that any medical treatment given will be of a first aid treatment type only. I consent that any pictures furnished by me or any pictures taken of me in connection with the Tournament can be used for publicity, promotion or television showing now or in the future, and I waive compensation in regard thereto. All participation in any event or class in this Tournament is by permission only. The Director or his authorized agent(s) reserve the right to refuse entry to any person, school, team or club. 6. Understands that the tournament directors reserve the right to combine or cancel any division, or place any individual competitor in a different division in accordance with their size, age, or experience level. 7. Statement of Health. By my signature below I confirm that I am in sound health and there is no reason why I cannot participate in this championship and/or event. The undersigned have read the above waiver and release, understand that they have given up substantial rights by signing it and sign voluntarily 1. Date: 2. Date: 3. Date: Signature of Contestants (if under 18 - Signature of Parent or Guardian)

5 801 El Margarita, Yuba City, CA Kumite Team Competition Registration One Team Entry $45 10&under &up Team Name: Instructor s Name: Dojo Name: Dojo Address Total Fees Paid. Make checks payable to: NCKF 950 Tharp Rd, Ste. 1200, Yuba City, CA (530) Pre-registrations must be received by March 20, 2015 $15 charge for at the door registrations 1. Female-Name Birth Date 2. Male-Name Birth Date 3. Male-Name Birth Date In consideration of being allowed to participate in any way in the Northern California Karate-Do Federation, Inc. qualifier, and related events and activities, the undersigned: 1. Agrees that prior to participating, they (if under 18 Parent or Guardian), will inspect the facilities and equipment to be used, and if the participant and/or Parent/ Guardian, believes anything is unsafe, they will immediately advise their coach or supervisor or Miladi Karate Academy personnel of such condition(s) and refuse to participate. disability and death, and severe social and economic losses which might result not only from their own actions, inactions or negligence but the actions, inactions or negligence of others, the rules of play, or the condition of the premises or of any equipment used. Further, that there may be other risks not known to us or not reasonably foreseeable at this time. 4. Releases, waives, discharges and covenants not to sue Northern California Karate-Do Federation, Inc., Jacobs Jr. High School, its officers, its affiliated clubs, regional sports organizations, their respective administrators, directors, agents, coaches and other employees of the organization, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessees of premises used to conduct the event, all of which are hereinafter referred to as releasees from any and all liability to each of the undersigned, his or her heirs and next of kin for any and all claims, demands, losses or damages on account of injury including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the releasee or otherwise. 5. All entries are final, no refunds will be given. I fully understand that any medical treatment given will be of a first aid treatment type only. I consent that any pictures furnished by me or any pictures taken of me in connection with the Tournament can be used for publicity, promotion or television showing now or in the future, and I waive compensation in regard thereto. All participation in any event or class in this Tournament is by permission only. The Director or his authorized agent(s) reserve the right to refuse entry to any person, school, team or club. 6. Understands that the tournament directors reserve the right to combine or cancel any division, or place any individual competitor in a different division in accordance with their size, age, or experience level. 7. Statement of Health. By my signature below I confirm that I am in sound health and there is no reason why I cannot participate in this championship and/or event. The undersigned have read the above waiver and release, understand that they have given up substantial rights by signing it and sign voluntarily 1. Date: 2. Date: 3. Date: Signature of Contestants (if under 18 - Signature of Parent or Guardian)