Intramural Karate Exhibition

Parent Name *

First Name

Last Name

Phone *

(###)

###

####

Child #1 name *

First Name

Last Name

Child #1 Events *

Check all that apply

Individual kata

Team kata

Point sparring

Flag sparring

Child #2 name

First Name

Last Name

Child #2 Events

Check all that apply

Individual kata

Team kata

Point sparring

Flag sparring

Child #3 name

First Name

Last Name

Child #3 Events

Check all that apply

Individual kata

Team kata

Point sparring

Flag sparring

Medical Release *

By clicking the "I Agree" you are electronically signing this agreement indicating that you have read, and understand and agree to the terms and conditions, refund policy, release of liability, and you are 18 years of age or older. If the registrant(s) is a minor / are minors under 18 for this event you attest that the name entered as the parent or legal guardian is the name of the person accepting the agreement and is in fact the parent or legal guardian of the registered minor(s).

Adult & Minor Amateur Athletic Waiver and Release of Liability In consideration of being allowed to participate in any way in the NW School of Karate Intramural Exhibition, 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 or Guardian, believes anything is unsafe, they will immediately advise their coach or supervisor or Northwest School of Karate personnel of such condition(s) and refuse to participate.

2. *

Acknowledge and fully understand that each participant will be engaging in activities that involve risk of serious injury, including permanent 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. Assume all the foregoing risks and accept personal responsibility for the damages following such injury, permanent disability or death.

3 *

Release, waive, discharge and covenant not to sue the St. Bernadette Parish School, St. Bernadette Parish, Northwest School of Karate, 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.

4. *

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 Exhibition can be used for publicity, promotion or television showing now or in the future, and I waive compensation in regard thereto. All participants in any event or class in this Exhibition is by permission only. The Director or his authorized agent(s) reserve the right to refuse entry to any person, school, team or club.

5. *

PLEASE NOTE: All athletes must be covered by health or medical insurance in order to compete.

6. *

Statement of Health. By my and/or Parent/Guardian's 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.

Agreement *

I agree and confirm I have read the Medical Release Form and fully understand its contents.

Parent or Guardian Name *

First Name

Last Name