60th Annual Obukan Judo Shiai and Kata / Onchi Sensei Memorial Tournament Sponsored by Obukan Judo Dojo, Inc. Sanctioned by the USJF (# )

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1 60th Annual Obukan Judo Shiai and Kata / Onchi Sensei Memorial Tournament Sponsored by Obukan Judo Dojo, Inc. Sanctioned by the USJF (# ) Tournament date: Saturday, March 19, 2016 Eligibility: Tournament Site: Competition Start: Information: Tournament Hotel: Contestants must be an amateur athlete and must have a current USJF card, USA Judo or USJA membership and present card. PCC Cascade Campus Gym, 600 N. Killingsworth St. Portland. OR Kata starts at 8:30 AM, Shiai starts at 10:00 AM Mark Hirota or Rod Conduragis , The Red Lion on the River 909 N Hayden Island Drive, Portland, OR Use the passkey for special tournament rate: Shiai: Registration (on or before March 17th): Enter tournament on-line at obukanjudo.org by March 17, Bring printed and signed waiver form to weigh-in. Entry fee is $35 for the first division and $20 for an additional division. Walk Up Registration (after March 17th): After March 17th, bring printed and signed waiver and entry form to weigh-in. Entry fee is $50 for the first division and $30 for an additional division. Kata: Registration (on or before March 17th): Enter tournament on-line at obukanjudo.org by March 17, Entry fee is $60 per team for each kata. Teams can enter up to three kata. Nage no Kata, Katame no Kata and Ju. Walk Up Registration (after March 17th): After March 17th, bring printed and signed waiver and entry form to weigh-in. Entry fee is $60 per team for each kata. Teams can enter up to three kata. Nage no Kata, Katame no Kata and Ju. Weigh Ins: March 18th, 6-8:30 PM and March 19th, 7:30 AM- 9:00 AM Officials Meeting: Officials, coaches and managers, Saturday 9:00 AM. Head Referee: Julie Koyama-PJC. NW Class R certification is available by the NWYDK Referee Committee.

2 Kata Format Eligible teams include all female, all male and mixed pairs. Teams may compete in one or more kata, though an individual may only compete in each kata once. Changes in the above may be made at the discretion of the Tournament Committee. First, Second and Third place will be awarded in each kata. Shiai Format Divisions with 6 or more contestants will use a modified double elimination bracket, the champion will not have a loss. Divisions with 5 or less contestants will use a pool bracket Changes in the above may be made at the discretion of the Tournament Committee. No contestant may move down an age group. First, Second and Third place will be awarded to the Divisions indicated below. Shiai Age and Weight Divisions Bantam * (8 and Under) Intermediate 1 (9 and 10 yrs) Intermediate 2 (11 and 12 yrs) Juvenile A (13 and 14 yrs) Cadet (15, 16 and 17 yrs) Senior Novice (Up to 4th Kyu) Brown Belt Black Belt Veterans (35 yrs +) *Bantam divisions could be co-ed, depending on the numbers of entries. Divisions will be based on age (as of the day of the tournament) or rank and actual weight. Based on available contestants, every attempt will be made to ensure fair competition for all contestants. If a contestant moves up to a division by their own choice, they will be subject to the rules for that division. If a contestant moves up to a division, at the request of the Tournament Committee and with their concurrence, they will be identified and subject only to the rules pertaining to their original age/rank division.

3 rules with the following modifications: Junior Divisions Div Bantam* Interm 1 Interm 2 Juv A Cadet Novice 15, 16 8 and 9 and and 13 and 14 and 17 over 17 Age under yrs 12 yrs yrs yrs Senior Divisions Brown Black Belt Belt yrs N/A N/A Veterans 35 yrs+ Men= 3 = 3 min Match Time 3 min 3 min 3 min 3 min 4 min Shime- Waza No No No Yes Yes Yes Yes Yes Yes Kansetsu- Waza No No No No Yes No Yes Yes Yes Blue Gi Mandatory Yes Yes Yes Yes Yes Yes Yes Yes Yes Medical Rules Gi *-Bantam divisions could be co-ed, depending on the numbers of Judo Gi rule for fit enforced (increased sleeve length and top cross over). Approved Judogi not required. Contest area: 8 meters x 8 meters Safety area: 3 meters with 4 meters between contest areas.

4 ENTRY FORM 60th Annual Obukan Judo Shiai and Kata / Onchi Sensei Memorial Tournament March 19, 2016, Sanctioned by the USJF (# ) Contestant s Name: Address: City: State: Phone: Age: Male: Female: Weight: Rank: Dojo/Club: USJF, USA Judo or USJA Card Number: Expiration : In consideration of your accepting this entry, I, intending to be legally bound hereby for myself, my heirs, executors and administrators, waive the release any and all rights or damages that I may have against the Obukan Judo Dojo Inc. and the member clubs, officials and members of the Northwest Yudanshakai, or United States Judo Federation for any and all injuries suffered by me at said event. Signature of Contestant Signature of Parent or Guardian (if under 18 years of age) If assistance/accommodation is needed (check off appropriate box): Vision loss / Blindness Hearing Loss / Deafness Type of assistance /accommodation requested or name of person assisting: CERTIFICATE REGARDING NON-BLACK BELT CONTESTANT I,, a judo instructor who holds the judo rank of (must be Shodan or higher) under the auspices of a nationally recognized organization, who is currently registered with a national Judo Organization, hereby certify that,, a non-black belt competitor is competent to participate in the 60th Annual Obukan Judo Shiai and Kata / Onchi Sensei Memorial Tournament Instructor s Signature Organization Registration Number Expiration

5 WARNING! WAIVER AND RELEASE OF LIABILITY AND AGREEMENT TO PARTICIPATE (Including Limited Co-Ed Competition for Age 10 and Under for USJF Sanction) In consideration of being permitted to participate in any way, including travel to and from, in any Judo tournament, practice, clinic, and related events and activities ( Activity ) of the United States Judo Federation, Inc., USA Judo/United States Judo, Inc., United States Judo Association, Inc., Northwest Judo Yudanshakai, Inc., Obukan Judo Dojo, Inc., and the PCC Cascade Campus Gymnasium, I agree: 1. I understand the nature of Judo activities and believe I am qualified to participate in such Activity. I also understand the rules governing the sport of Judo. 2. I further acknowledge that prior to participating, I will inspect the mats, equipment, facilities, competition pools or divisions, and the elimination or scoring system to be used, and if I believe anything is unsafe or beyond my capability, I will immediately advise my coach, supervisor, and/or a tournament official of such conditions and refuse to participate. 3. I acknowledge and fully understand that I will be engaging in a contact sport that might result in serious injury, illness or disease, including permanent disability or death, and severe social and economic losses due not only to my own actions, inactions or negligence, but also to the actions, inactions, or negligence of others, the rules of the sport of Judo, or conditions of the premises or of any equipment used. Further, I acknowledge that there may be other risks not known to me or not reasonably foreseeable at this time. 4. Knowing the risks involved in the sport of Judo, I assume all such risks and accept personal responsibility for the damages following such injury, illness, disease, permanent disability, or death. 5. I hereby release, waive, discharge and covenant not to sue the United States Judo Federation, Inc., USA Judo/United States Judo, Inc., United States Judo Association, Inc., Northwest Judo Yudanshakai, Inc., Obukan Judo Dojo, Inc., and the PCC Cascade Campus Gymnasium, together with their affiliated clubs, their respective administrators, directors, officers, agents, coaches, and other employees or volunteers of the organization, event officials, medical personnel, other participants, their parents, legal guardians, supervisors and coaches, sponsoring agencies, sponsors, advertisers, and if applicable, owners, lessors, and lessees of premises used in conducting the event, all of whom are hereinafter referred to as "Releasees", from any and all litigation expenses, attorney fees, loss, liability, damage or costs on account of injury, illness, disease, including permanent disability and death or damage to property, caused or alleged to be caused in whole or in part by the negligent acts or omissions of the Releasees or otherwise to the fullest extent permitted by law. I HAVE READ THE ABOVE WARNING, WAIVER, AND RELEASE, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND KNOWING THIS, SIGN IT VOLUNTARILY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE. CONSISTENT WITH THE BY-LAWS OF USJF, THIS TOURNAMENT MAY INCLUDE CO-ED COMPETITION FOR AGES 10 AND UNDER IN COMPARABLE AGE/WEIGHT DIVISIONS WHERE THERE IS AN INSUFFICIENT NUMBER OF GIRLS FOR NON-CO-ED AGE/WEIGHT DIVISIONS. I HAVE READ AND UNDERSTAND THE TOURNAMENT ANNOUNCEMENT CONCERNING THESE SPECIAL DIVISIONS. I AGREE TO PARTICIPATE KNOWING THE RISKS AND CONDITIONS INVOLVED AND DO SO ENTIRELY OF MY OWN FREE WILL. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENT/LEGAL GUARDIAN AS EVIDENCED BY THEIR SIGNATURE BELOW. I INTEND THIS TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THAT THE BALANCE, NOTWITHSTANDING SHALL CONTINUE IN FULL FORCE AND EFFECT. Participant Participant s Signature FOR PARENTS/LEGAL GUARDIANS OF PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT TIME OF REGISTRATION) This is to certify that I, as parent/legal guardian with legal responsibility for this participant, do consent and agree to his/her release, as provided above, of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child s involvement or participation including litigation expenses, attorney fees, loss, liability, damage or costs which may incur as the result of the minor child s participation in these programs as provided above, even if arising from their negligence, to the fullest extent permitted by law. I have instructed the minor participant as to the above warnings and conditions and their ramifications. Parent/Legal Guardian Parent/Legal Guardian s Signature Form 514, V6.0.0,

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