2014 Intramural Games Student Kung Fu Competition

2014 Intramural Games Student Kung Fu Competition

Saturday, December 13, 2014• 9:30 – 5:30 pm

Venue: Shaolin Temple Culture Center, 4343 Peralta Blvd., Fremont, CA 94536

Registration FormTraining Location:

First Name: Last Name:Student #Belt Level:

Date of Birth:Age:Tel: E-Mail:

EVENT #EVENT/FORM NAMEFEERegistration Deadline: 11/30/2014

1st individual event#$ ($20/person)

2nd individual event#$ ($15/person)

3rd individual event#$ ($15/person)

4th individual event#$ ($15/person)

Team event# 34$ ($15/person)

Family event# 35$($15/person)

Sparring Event# 36$($15/person)

School Teams Event# 37$($15/person)

Total Amount Due:$ Processed by: Date:

Payment Method:

( ) Cash( ) CheckBank:Check #Date of check:

( ) Visa ( ) MastercardCard #Expiration Date:Security Code:

Card Holder Name:Billing Address:

Card Holder Signature to authorize electronic payment from this credit card:Date:

I confirm that I have read, understand and agree to abide by the competition rules and the followingterms and conditions.

1.Completed registration form and all fees must be received by Shaolin Temple USA on or before 11/30/2014 to qualify for participation in competition. 2. There will be NO refund for any registration, including withdrawal or absence from any event regardless of reason. 3. I accept all rules and regulations set forth by Shaolin Temple USA for this event. Events and rules are subject to change without notice. 4. Events may be combined or canceled due to insufficient participants.

Waiver and Release

1. Assumption of Risk. I AM AWARE THAT PARTICIPATION IN A KUNG FU/MARTIAL ARTS COMPETITION IS A HAZARDOUS ACTIVITY. I AM VOLUNTARILY PARTICIPATING IN THESE ACTIVITIES WITH KNOWLEDGE OF THE DANGER INVOLVED, HEREBY AGREE TO ACCEPT ANY AND ALL RISKS OF INJURY OR DEATH, AND VERIFY THIS STATEMENT BY PLACING MY SIGNATURE BELOW: 2. Release. As consideration for being permitted by Shaolin Temple USA to participate in these activities and use related facilities, I hereby agree that I, my assignees, heirs, distributees, guardians, and legal representatives will not make a claim against, sue, or attach the property of Shaolin Temple USA on account of injury or damage resulting from the negligence or other acts, howsoever caused, by any employee, agent, or contractor of Shaolin Temple USA as a result of my participation in the competition. I hereby release Shaolin Temple USA from all actions, claims, or demands that I, my assignees, heirs, distributees, guardians, and legal representatives now have or may hereafter have for injury or damage resulting from my participation in the competition. 3. Photo and Video Release.I understand that during the SHAOLIN TEMPLE USA 2014 INTRAMURAL GAMES STUDENTS KUNG FU COMPETITION photographs and videos may be taken of me before, during or after the competition, that the same may be used for publicity for Shaolin Temple USA, Shaolin Temple Culture Centers, and the same may be used for television or on the Internet, and I waive all rights, title and interest in such photographs or video and waive all claims to compensation for them.4. Knowing and Voluntary Execution. I HAVE CAREFULLY READ THIS RELEASE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN ME AND SHAOLIN TEMPLUE USA AND SIGN IT ON MY OWN FREE WILL.

Signature of StudentDate

Signature of Parent/Legal Guardian if under 18 Relationship to StudentDate

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