29th Lower Mainland Colored Belt Championships

February 27, 2016 at Frank Hurt School - 13940 – 77th Avenue, Surrey

NAME: ______(Please Print Clearly)

DOJO: ______IKO MEMBERSHIP #: ______

HEIGHT: ______WEIGHT: ______D.O.B.: ______

INSTRUCTOR: ______PHONE: ______

I understand that this registration for the above mentioned tournament may be terminated at any time. I have chosen to participate in the Annual Lower Mainland Coloured Belt Tournament and I understand there are risks involved in any physical activity. I therefore choose to participate not holding any sponsoring company, organization or individual responsible should any injury of any nature occur while taking part in this tournament. Upon being accepted to participate in the tournament, I will obey all the rules and regulations governing said tournament. I agree that this registration may be cancelled at any time.

SIGNED: ______DATE: ______

PARENT OR GUARDIAN SIGNATURE: ______

(IF UNDER 19 YEARS OLD)

Tournament Fees: $25 for 1 Division and $40 for 2 divisions

CONTINUOUS NON -CONTACT

12 years & under (boys & girls) White to orange stripeBlue and above

____ 50 lbs & under______

____ 51 to 60 lbs______

_____ 61 to 70 lbs______

_____ 71 to 90 lbs______

_____ 91 to 110 lbs______

_____ 111 lbs and over______

_____ 13 to 15 years____ Female____ Male

_____ 16 years & over____ Female____ Male

KNOCKDOWN:

_____ 12 & under - 50 lbs & under

_____ 12 & under – 51 – 60 lbs_____ 12 & under –61 lbs – 70 lbs

_____ 12 & under – 71 – 85 lbs_____ 12 & under – 86 - 100 lbs

_____ 12 & under – 101 lbs & over

_____ Boys C.B. 13 & 14 years_____Girls C.B. 13 & 14 years

_____Boys C.B. 15 & 16 years_____Girls C.B. 15 & 16 years

_____Mens C.B. 17 & 18 years_____Womens C.B. 17 & 18 years

_____Womens 19 & over ____ LW (135 lbs & under)____ HW (136 lbs & over)

_____Mens C.B. 19 & over ____ LW (165 lbs & under)____ HW (166 lbs & over)

_____Seniors(35 years & over)____ Female____ Male

_____Open Division ____ LW (165 lbs & under)____ HW (166 lbs & over)

** Some divisions may be combined depending on the number of entries**