Competitors Name *

First Name

Last Name

Phone *

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent / Guardian if under 18 *

First Name

Last Name

Birth Date *

MM

DD

YYYY

DIVISIONS *

Kata

SPARRING

By Checking the boxes below I acknowledge the Rules, terms and conditions of this event. I (the Competitor) hereby waive the rights for myself and / or my child (the Competitor) to any and all claims against Rocky Whatule, Zanshin Shotokan Karate Club, The RAW Group, and The CUBE Santa Clarita all other persons and sponsors associated with this event in any capacity from any and all liability due to injuries that may incur as a result of my attendance and /or participation at this event. I understand the rules of the tournament WKC Modified and will abide by them. I understand that I am participating in a sport that has body contact. I assume full responsibility for all of my actions during and connected to the above tournament. I understand the risk of competing in this event in both Kata and Kum Sparring divisions and hereby release the event organizers and all of its employees, associates, tournament sponsors, and the event facility, from any type of injury, loss, or death sustained while competing in this competition. I also state that I am in good mental and physical condition and know of no reason why I or my child could not participate in this event. I have current and valid health Insurance. In case of an emergency, I hereby authorize any licensed medical personnel to perform any accepted medical procedure deemed necessary and I agree to bear the Expense of any such treatment. I agree that my attendance and/or performance at the tournament may be photographed, filmed, or taped and used by any schools, business, or sponsors and I waive any compensation thereof. I have read understand and agree to abide by the rules associated with this event. Media Release – I, Member/guardian, give permission for images of Member, captured during regular and special activities through video, photo and digital to be used solely for the purposes of promotional material and publications, and waive any rights of compensation or Ownership thereto. I, Member/guardian, know the Member represents being physically fit to take the prescribed program. All use of the facilities shall be under taken at the sole risk of the Member/guardian. I HEREBY FOREVER RELEASE, DISCHARGE AND COVENANT NOT TO SUE ZANSHIN SHOTOKAN KARATE. I ACKNOWLEDGE THAT I HAVE HAD SUFFICIENT OPPORTUNITY TO REVIEW THE PROVISIONS OF THIS DOCUMENT AND UNDERSTAND ITS PURPOSE, MEANING AND INTENT. I HAVE READ THE ENTIRE RELEASE, I FULLY UNDERSTAND IT, AND I AGREE TO BE LEGALLYBOUND BY IT. *

I AGREE TO TERMS AND RULES

I AGREE TO LIABIITY WAIVER

I AGREE TO MEDIA RELEASE