| * Name |
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| * Age |
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| * Sex |
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| * Belt Rank |
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| * Club Name |
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| * City |
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| * Address |
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| P7G3W2* Postal / Zip Code |
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* Division
$35.00 is for registrations prior to April 1st and $45.00 after and up until April 4th . No on-line registration will be accepted after April 3rd. All additional events Traditional or Open $5.00 each.
Competitors crossing over styles pay $5.00 CND for every crossed over event.
"New Event for Open Divisions is Traditional Weapons" indicate in comments area if wanting to partisipate. |
Creative:
Form
Sparring
Musical
Weapons
Club Traditional:
Kata
Kumite
Team Kata |
| 1-807-222-2222* Home Phone Number |
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| * Email Address |
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Parents' / Guardians' Names (if under 16)
use , to separate |
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* List any allergies /
Current Medications or
Medical Conditions
type in "None" if you don't have any |
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| * Payment options |
I will pay the day of the tournament
I would like to be contacted for advanced registration payment options
I will mail a cheque to
Mac Open 2005 - Thunder Bay Martial Arts Council,
1320 Rosslyn Rd. Thunder Bay Ontario P7E6W1
Please make cheques payable to Victor Cooke |
| Comments |
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All information will be kept in the strictest of confidence. These information are being collected for reasons of safety and for contact purposes only.
In the event of an emergency, these information can be given to the attending paramedics.
Note that this is an advanced registration intended to provide you a spot in the tournament, you (and your parent / guardian if you are under 16 years old of age) must sign a printed copy of your registration at the advanced registration desk on the day of the tournament in order to participate. |
Waiver, Release and Indemnity Agreement:
Release, Waiver and Indemnity: We the undersigned herby grant permission for the above named student to participate in this activity and absolve the Thunder Bay Martial Arts Council, Canadian Forces Thunder Bay Armories and YCC Productions and its staff and any other person associated with this event from any liability for injury of loss sustained by the student while engaged in this activity and voluntarily release, forever discharge and agree to indemnify and hold harmless all of the above parties from any and all claims, demands, or causes of actions which are in any way connected with participation in this activity, including claims which allege negligent acts or omissions of all the above parties.
I realize that this event may involve known or unanticipated risks. Student participation in this activity is purely voluntary and the above named student elects to participate in spite of any possible risks. As the student? parent or legal guardian, I agree to be responsible for any injury or damage that he or she may cause or suffer while participating. |
By clicking on the "Submit Form" button you accept
that you have read and agree to the Waiver Agreement (above). |
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