Contents
Table of Contents……………………..…………………………………………………………………………………1
General Information…………………………………………………………………………………………………….2
Important Deadlines…………….………………………………………………………………………………………….3
Schedule of Events………………………………………………………………………………………………………….4
Schedule of Events (continued)……….……………………………………………………………………………5
Fees and Admission Prices…………………………………………………………………………………………….…….6
Competitor Checklist and Dan Exam Fees ...... 7
Dan Exam Form ...... 8
Selection of Judges Form...... 9
Waiver/Release Agreement………………………………………………………………………...... 10
Contestant’s Medical Questionnaire...... 11
General Contest Rules ...... 12
Adult Division ‐ General Information...... 13
Adult Individual Black Belt Club Representative Seeding Form...... 14
Color Belt Adult Individual Registration Form...... 15
Brown Belt Adult Individual Registration Form...... 16
Black Belt Adult Individual Registration Form...... 17
Black Belt Adult Team Registration Form...... 18
International Goodwill Team Registration Form...... 19
Senior Division – General Information ...... 20
Senior Individual Registration Form...... 21
Senior Team Registration Form...... 22
Collegiate ‐ General Information...... 23
Collegiate Individual Registration Form...... 24
Collegiate Team Registration Form ...... 25
Youth Division – General Information ...... 26
Youth Individual Registration Form...... 27
Youth Team Registration Form ‐ Kata Only ...... 28
T‐Shirt Order Form ...... 29
Banquet Reservation Form...... 30
Program Advertising Form...... 31
Travel & Hotel Information………………………………..………………………………………………………32
2014 JKA/AF Nationals and Collegiate Goodwill Tournament
General Information
Event: JKA American Federation Nationals & Collegiate Goodwill Tournament
When: November 8 – 9, 2014
Where: University of New Orleans
Health & P. E. Center
New Orleans, Louisiana
For information: Tournament Website: www.jkaaf.org
Or contact
JKA American Federation
Phone 504-835-6825 Fax 504-835-6825
Email:
Make Payments to: JKA American Federation
Mail to: JKA American Federation
706-C Phosphor Ave.
Metairie, LA 70005
2014 JKA/AF Nationals and Collegiate Goodwill Tournament
Important Deadlines
Hotel Reservations: list and information to follow
Advertising Entries: Form included on page 30
Tournament Judges: See enclosed judges selection form
Dan Examination Registrations: Post Marked October 30, 2014
Must pre-register if you are testing
Tournament Registrations: Post marked October 30, 2014
All Participants must check in Friday November 7th, 2014at JKA/AF Headquarter from 12 n00n to 8 p.m.
Who Can Participate
Tournament:
The Tournament is open to any Shotokan school in the United States as well as International clubs, regardless of organization or affiliation. Competitors may participate in any event they qualify for ‐based on age, rank and gender. The tournament will follow JKA rules.
Dan Examinations:
JKA/AF members (only)
Exam will be held on Friday, November 7, 2014
Pre‐registration must be done if you are planning to test.
2014 JKA/AF Nationals and Collegiate Goodwill Tournament
Schedule of Events
Friday, November 7, 2014
10:00am to 9:00pm Check‐In for all competitors at Louisiana Karate Association
706 Phosphor Avenue, Metairie, LA 70005
* Late registrations will be assessed a $20 fee per contestant.
1:00pm to 2:00pm Seminar taught by Master Takayuki Mikami
at Louisiana Karate Association
* Registrations will be done on‐site. Cost is $25.
3:00pm to 4:30pm Dan Examinations (Shodan to Yondan)
at Louisiana Karate Association
* Pre‐registration required
Saturday, November 8, 2014
8:30am to 9:00am Late Check‐Ins (No registrations will be taken on this day)
8:45am Judges Meeting
9:00am Tournament Begins
Competition Eliminations – Finals Youth (up to 12 yrs)
Competition Eliminations – Collegiate, Senior and Adult Divisions
Competition Eliminations – Goodwill Team Events
8:00pm Banquet : New Orleans Yacht Club
403 Roadway Street
New Orleans, LA 70124
Sunday, November 9, 2014
9:00am Doors Open
10:00am Opening Ceremony
Demonstration
Youth Final Events Boys (13 – 14) Brown & Black Belts
Kata: 3 finalists Kumite: 2 finalists
Girls (13 – 14) Brown & Black Belts
Kata: 3 finalists Kumite: 2 finalists
Boys (15 – 16) Brown & Black Belts
Kata: 3 finalists Kumite: 2 finalists
Girls (15 – 16) Brown & Black Belts
Kata: 3 finalists Kumite: 2 finalists
Boys (15 – 16) Brown & Black Belts
Kata: 3 finalists Kumite: 2 finalists
Girls (15 – 16) Brown & Black Belts
Kata: 3 finalists Kumite: 2 finalists
Youth Team Kata 2 finalists Team Kumite 2 finalists
2014 JKA/AF Nationals and Collegiate Goodwill Tournament
Schedule of Events (continued)
Collegiate Final Events Women (Brown and Black Belt)
Kata: 3 finalists Kumite: 2 finalists
Men (Brown and Black Belt)
Kata: 3 finalists Kumite: 2 finalists
Team (Mixed) Kata 2 finalists
Women’s Team Kumite 2 finalists
Men’s Team Kumite 2 finalists
Senior Final Events Women (Brown and Black Belt)
Kata: 3 finalists Kumite: 2 finalists
Men (Brown and Black Belt)
Kata: 3 finalists Kumite: 2 finalists
Team (Mixed) Kata 2 finalists
Women’s Team Kumite 2 finalists
Men’s Team Kumite 2 finalists
Adult Final Events Women (Brown and Black Belt)
Kata: 3 finalists Kumite: 2 finalists
Men (Brown and Black Belt)
Kata: 3 finalists Kumite: 2 finalists
Women’s Team Kata 3 finalists
Women’s Team Kumite 2 finalists
Men’s Team Kata 3 finalists
Men’s Team Kumite 2 finalists
International Goodwill Team Events
Women’s Team Kata 3 finalists
Women’s Team Kumite 2 finalists
Men’s Team Kata 3 finalists
Men’s Team Kumite 2 finalists
Closing Ceremonies Awards Presentation and Closing ceremonies
NOTE: DIVISIONS SUBJECT TO CHANGE
2014 JKA/AF Nationals and Collegiate Goodwill Tournament
Fees and Admission Prices
Tournament Fees:
Youth Division Individual, Single Event $35
Individual, Both Events $45
Team (one or both) $65
Collegiate Division Individual, Single Event $35
Individual, Both Events $45
Team (one or both) $65
Senior Division Individual, Single Event $45
Individual, Both Events $55
Team (one or both) $100
Adult Division Individual, Single Event $45
Individual, Both Events $55
Team (one or both) $100
International Goodwill Team Events (one or both) free
IMPORTANT: Registrations received postmarked after October 30, 2014 will be assessed a $20 late fee per contestant.
Spectator Admission Prices: Competitors and Judges in uniform are free.
$6 One‐Day Pass
$10 Two‐Day Pass
No charge for children 10 years old and under.
2014 JKA/AF Nationals and Collegiate Goodwill Tournament
Competitor Checklist and Dan Exam Fees
COMPETITOR CHECKLIST
______Mouthpiece
______Gloves (white naugahyde)
______Current JKA/AF Card or JKA passport for JKA/AF members
______Current student ID card (2013)
______Standard White Gi
Dan Examination will take place Friday, November 7, 2014 at 3:00pm at Louisiana Karate Association.
DAN EXAMINATION FEES- payable to JKA/AF
Shodan $ 80.00
Nidan $100.00
Sandan $120.00
Yondan $150.00
DAN REGISTRATION FEES- (must be paid with exam fee) ‐ payable to JKA/AF
Shodan $130.00
Nidan $170.00
Sandan $225.00
Yondan $270.00
Godan $550.00
IMPORTANT: Pre‐registration required and must be postmarked no later than October 30, 2014.
Please make check or money orders payable to: JKA American Federation
Please send to: 706-C Phosphor Ave.
Metairie, LA 70005
2014 JKA/AF Nationals and Collegiate Goodwill Tournament
Dan Exam Form
Please type or print clearly.
Name______
Date of Birth______/______/______
Gender M / F Rank (dan)______
Address ______
City ______State ______Zip ______Country ______
Telephone ( )______Fax ( )______E-Mail ______
Dojo ______
Dan rank you are testing for: ______
Signature______
Date______
List previous JKA Dan registration numbers (if applicable):
Rank / Registration Number / Date of Exam / Chief Instructor/Examiner’s nameShodan
Nidan
Sandan
Yondon
IMPORTANT: All Examinees must be members of the Japan Karate Association through Affiliations
officially recognized by the JAPAN KARATE ASSOCIATION and have a current JKA passport.
Your Chief Instructor must sign Dan Registration Form.
2014 JKA/AF Nationals and Collegiate Goodwill Tournament
Selection of Judges Form
Judges must meet the requirements as established by t he JKA/AF and the JKA. The Chief Instructor and/r tournament director will designate the Chief Judge and Arbitrator.
This is to confirm that the following persons wills serve as Judges at the 2014 JKA/AF National Karate Tournament and Collegiate Tournament.
Club:______
Name Dan Rank Judge's Rank
(A, B, C, D or none)
1. ______
2. ______
3. ______
4. ______
5. ______
6. ______
Signature of Club Director:______
This information must be postmarked no later than October 30, 2014.
ALL JUDGES MUST SHOW VALID JKA QUALIFICATION CARD
2014 JKA/AF Nationals and Collegiate Goodwill Tournament
Waiver/release agreement
PARTICIPANT’S MEDICAL QUESTIONNAIRE:
To be completed by all adults and guardians of minors attending the JKAAF National Tournament 2010.
Name______Date of Birth______Sex______Rank______
Address______City ______State_____ Zip______
Organization______Country ______Dojo ______
Do you have a history of any of the following conditions? Please check either yes or no for each one.
If you answer yes to any, please explain:
Yes No
______Heart murmur
______Hypertension
______Recent infection
______Bone fracture in the past six months
______Concussion or severe head injury in the past six months
______Seizures
______Eye injury
______Severe bone bruises requiring padding
______Kidney injury
______Allergy to medication (list all):
______Are you currently taking any medications? If yes please specify ______
______Other:______
______Date ______
Signature of Participant (Parent or Guardian if under 18 years of age)
WAIVER/RELEASE AGREEMENT: Event: the JKAAF National Tournament 2014. I understand that there are risks and dangers inherent in martial arts training and in participating in and/or receiving instruction at the EVENT. I understand and agree that by signing this Waiver/Release, I am assuming full responsibility for any and all risk of personal injury or death or for property damage suffered by me while participating in and/or receiving instruction at the EVENT. I expressly acknowledge that my participation in the EVENT may subject me to personal injury or bodily harm and I assume any and all risks of that participation. I also understand that in order to be allowed to participate
in and/or receive instruction at the EVENT, I must give up my rights to hold the JKA American Federation and its affiliates, All South Karate Federation , University of New Orleans, and any and all other clubs, schools, instructors, members, judges, officials, representatives and all other participants (collectively the “Releasees”) liable for any injury or damage which I may suffer while participating in and/or receiving instruction at the EVENT.
I also understand and agree that by signing the Waiver/Release, I acknowledge that I am solely responsible for having or obtaining all insurance coverage which may be necessary or desirable in connection with my participation in and/or receipt of instruction at the EVENT and for any travel to and from the EVENT and in all lodging or any other activities which may be related directly, indirectly or incidentally to the foregoing. I further understand and agree that any fees or costs required for necessary or requested medical attention shall be my sole responsibility and that I shall not seek indemnification or contribution from any Releasee in connection therewith. I also understand that the Releasees shall not be responsible for any incidental, consequential or exemplary damages of any kind even if they are notified of the possibility of such in advance. I also understand and agree that any damage to any lodging sites or the tournament site that I cause is my full responsibility. In no case are said damages the responsibility of any of the Releasees. I further understand and agree that as consideration for my participation in the EVENT, the JKA American Federation and /or its designees shall have the right to use my name, image or likeness in the promotion of the EVENT or in any publication relating to the EVENT (or similar Events) and in any broadcast or rebroadcast transmission of the EVENT without any additional consideration to me for the use of my said name, image, audio/sound or likeness.
I understand and agree that this Waiver/Release will have the effect of releasing, discharging, waiving and forever relinquishing any and all actions or causes of action that I may have or have had, whether past, present or future, whether known or unknown, and whether anticipated or unanticipated by me, arising out of my participation in and/or receipt of instruction at the EVENT. Knowing this, and in consideration of being permitted to participate in and/or receive instruction at the EVENT, I hereby release and agree to indemnify
and hold harmless the above-named Releasees individually and their entities, and their officers, agents, principals, partners, shareholders, directors and employees from any and all liability or costs, including attorney fees, associated with or arising from my participation in and/or receipt of instruction at the EVENT. I further understand and agree that this Waiver/Release will be binding on my spouse, my heirs, my personal representative, my assigns, my children, any guardian ad litem and me for said children.
I understand that if I am signing this Waiver/Release on behalf of my minor child, that I will be giving up the same rights for said minor as I would be giving up if I signed this document on my own behalf. I acknowledge that I have read this Waiver/Release Agreement and that I understand the words and language in it.
Print Name______Date______
Sign Name______Witness______
2014 JKA/AF Nationals and Collegiate Goodwill Tournament
Contestants Medical Questionnaire
THIS FORM IS FOR MINOR PARTICIPANTS AND MUST BE FILLED OUT BY PARENT OR LEGAL GUARDIAN. PLEASE PRINT CLEARLY. ALL INFORMATION MUST BE SUPPLIED.
EMERGENCY CONTACT AND MEDICAL INFORMATION:
Name of Parent/Legal Guardian: ______
Address:______City______State______Zip______
Telephone ______(day) ______(night) Child’s Name:______
Any recent or present condition or injury: ______
My child is allergic to the following medications: ______
My child routinely takes the following medication: ______
Her/his last tetanus immunization was: ______
CONSENT FOR EMERGENCY TREATMENT:
Date: _____/_____ /_____
I hereby give permission to the Emergency Department at any hospital chosen or designated by the JKA American Federation to treat my son/daughter (name of minor):
Last Name ______First Name ______
while we are away. I understand this permission covers the average emergency such as strain, sprain, cut, bruise, scrape, bump, skin rash such as impetigo, poison oak or ivy, bites such as bee stings and snake bites, allergic reactions, foreign bodies in the eye or skin, upset stomach, diarrhea, pink eye, minor burns, sunburn, suspected minor fractures, minor concussions, fevers, diagnostic x-rays, suturing, and the like. I give permission for my child to receive a tetanus booster (if needed). This permission is valid for 6 months only. I also understand that in cases of major significance such as a fracture, appendicitis, or any illness or injury requiring admission that additional consents will be necessary for treatment and that the hospital will make every attempt to reach me. I can be reached at the above address.