| Registration Form (can be downloaded and copied for your use) |
| Mount Anthony Karate Center presents the 9th annual SIKARAN-Green Mountain Challenge Open Karate Tournament |
| Name______________________________________ Age___________ M / F Address______________________________________________________ City________________ State______________ Zip_____________ _________________________________________________________________________________________ Please Circle Events (s): FORM / WEAPONS / SPARRING Belt Rank/Color_____________________ Instructor/Sensei______________________ School: __________________________________________________________________ Address: __________________________________________________________________ Division: Mini Pee Wee _____ Pee Wee _____ Junior _____ White Belt _____ Green Belt _____ Brown Belt _____ Black Belt ______ I DO NOT WISH TO JUDGE ANY COMPETITON _______________ (Black Belt Only) |
| Registration Form |
| Please read and acknowledge the following waiver: In consideration of my entry into the Green Mountain Classic Open Karate Tournament, I do hereby assume all risk of personal injury, and acting for myself, my heir, personal representatives, and assigns, do hereby release the Officials, Officers, Agents, Representatives and Promoters of said Green Mountain Classic Open Karate Tournament (including Sikaran Institute of Karate, Mount Anthony Karate Center, Vermont Army National Guard and the Town of Bennington) individually, and collectively from all liability, including claims and suits at law or in equity of injury, fatal or otherwise, which may result directly from my traveling to, participating in, or returning from said tournament. I further agree to indemnify and hold harmless any official, officer, agent, representative, and promoter from any claim or judgement arising out of any accident, whether due to negligence, active or passive, on my part. That I freely and voluntarily executed this agreement and have not been induced in any manner or form to do so. I consent that any picture furnished by me or any picture taken of me in connection with said tournament can be used for publicity, or promotions, or television showing and waiver compensation in regard thereto. |
| _________________________________ ____________________ Signature of Participant Date ___________________________________ ______________________ Signature of Parent/Gaurdian (if under 18) Date |