To be held Saturday April 8, 2017 at St Stephen's Reformed Episcopal Church

2275 Liberty Road, Eldersburg, MD 21784

Doors open at 8:30 a.m. and the tournament will begin promptly at 9:30 a.m.

Registration Form

Please PRINT or TYPE LEGIBLY:

Name:______Age:______Sex:______

Address: ______City:______State: _____ Zip:______Phone Number:______

Height: ______Weight: ______Kyu Rank (Belt Rank):______Style:______Instructor’s Name:______

Email Address: ______

Attending Banquet: Yes______No______

Entering Events: KATA:_____ SHIAI:______WEAPONS:______

Entrance Fees:

post marked by
March 24, 2017
$50.00 per person
Families – 1st member $50 – subsequent family members $45

Non- refundable CHECK or Money Order

Please Read Carefully:

I, the undersigned hereby waive any and all claims, causes of actions losses, damages cost expenses against any and all persons connected with thE annual shorinjiryu Kenyukai watanabe-ha karate tournament, the sponsoring karate federation, japan karate center, anyone involved in anyway with the tournament oR ST. STEPHENS REFORMED EPISCOPAL CHURCHfor any injuries that i may sustain during and in competition with said tournament. I hereby acknowledge that there are possible risks of bodily injury involved in competing in the tournament. The following safety equipment is mandatory and must be worn: padded chest protector (supplied), Padded head gear (supplied), mouth guard (not supplied), and groinprotector (not supplied). No contact to the head, face, neck joint, BACK, or groin is permitted.

I have read, understood, and will comply with all tournament rules.

I agree that my performance or attendance at the competition or both may be filmed or other wise recorded or telecast live and I consent to use by the Shorinjiryu kenyukai WATANABLE- HA WORLD federation, it’s assignees and licenses of my name likeness, voice, poses, pictures, and biographical data concerning me, fully or in part, in any form or language with or without other material throughout the world without limitation, for television, radio and/or theatrical motion pictures, or any device now known or hereafter devised, and i waive any compensation therefore.

Date:______Signature:______

Signature of parent or Guardian

if under 18 years of age:______

Registration forms mailed after March 24, 2017 will not be accepted. Make checks payable to Japan Karate Center. $25.00 fee if check is returned. No Refunds. Mail completed registration forms along with payment to:

JAPAN KARATE CENTER

10429 Reisterstown Road

Owings Mills, MD 21117