BJJ & GRAPPLING REGISTRATION

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2 BJJ & GRAPPLING REGISTRATION Name male [ ] Female [ ] Weight Birth Date / / Age (print neatly) Address Home Phone ( ) City State Zip Years experience Martial Arts School Instructor Team Is this your first Kumite Classic? [YES] [NO] Did you stay at the Double Tree? [YES] [NO] Did you: [Fly] or [Drive] Please Circle All That Apply: [Mailing List] [kumiteclassic.com] [flyer/postcard ] [mixedmartialarts.com] [Martial Arts School] How did you hear about the Kumite Classic? If Referral, Who? Other GI (Jiu-Jitsu) NO GI (Grappling) Cross Over Both BJJ & Grappling SELECT YOUR AGE CATEGORY: Adult Male (18-29) Broken down by weight Executive (30-39) Broken down by weight Masters (40+) Broken down by weight Women Broken down by age and weight Teen (13-17) Broken down by age and weight Youth (12-) Broken down by age and weight NO GI (GRAPPLING) EXPERIENCE: Saturday May 25th Novice: under 1 Year training (no wrestling experience) Intermediate: 1-3 years training Advanced: More than 3 Years training GI (JIU-JITSU) EXPERIENCE: Saturday May 25th WHITE BLUE PURPLE / BROWN / BLACK Early Pre-Register: Before April 15th (get +free t-shirt) One Event $55.00 (one event) Crossover +$15.00 (both Gi & No-Gi) Pre-Register: Before May 15th (post mark) One Event $60.00 (one event) Crossover +$20.00 (both Gi & No-Gi) Registration: After May 15th The Door (May 24th) One Event $75.00 (one event) Crossover +$25.00 (both Gi & No-Gi) ALL postal mail must be post marked by May 15th After May 15th please the door. Pre-Register Money Order Payable To: Kumite Classic St. Nikolai Dr. North Huntingdon, PA Always keep a copy of your money order receipt. We are not responsible for lost registration materials. If you wish to (cross over) and enter both Gi & No-Gi you must register for both at the same time to take advantage of discounted rates. *We reserve the right to expand, create, or combine divisions to accommodate competitors or special circumstances. Information subject to change at the discretion of the coordinator and head referee. $ Sorry no refunds for any reason. Pre-register at your own risk. There are no substitutions or refunds for missing your divisions. TOURNAMENT RELEASE AND WAIVER I, (print name) the undersigned, hereby waive all claims against Kumite Classic Entertainment Corp., William Viola III, The Western Pennsylvania Police Athletic League Kumite International, The Monroeville Convention Center, and any and all other persons associated with this event in any capacity from any and all liability due to injuries that I may incur as a result of my attendance and/or participation at this event. I understand the rules of the tournament and will abide by them. I understand that I am participating in a sport that has body contact. I assume full responsibility for all of my actions during and connected to the above tournament. I understand the risk of competing in this form of Martial Arts competition and hereby release the event organizers and all of its employees and associates, tournament sponsors, and the event facility, from any type of injury, loss, or death sustained while competing in this competition. I also state that I am in good mental and physical condition and know of no reason why I cannot participate in this Martial Arts event. I have current and valid health insurance. Divisions or weight classes are subject to change. In case of an emergency, I hereby authorize any licensed medical personnel to perform any accepted medical procedure deemed necessary and I agree to bear the expense of any such treatment. I understand that a valid birth certificate may be required to compete at this event. I also agree that my attendance and/ or performance at the tournament may be photographed, filmed, or taped and used by any schools and I waive any compensation thereof. I have read, understand and agree to abide by the rules associated with this event and assume all responsibility and any associated liability for infringement of such rules and sign below to complete this form: Competitors Signature Date Signature of parent / guardian who assumes complete responsibility (if under the age of 18) Saturday May 25th Monroeville Convention Center - Download Full Flyer

3 IMPORTANT INFORMATION Event: 15th Annual Kumite Classic Promoter: Kumite Classic Entertainment Corp Director: Bill Viola Telephone: Website Date: Memorial Day Weekend Friday May 23rd: Early Weigh-ins Saturday May 24th GI BJJ Divisions Saturday May 24th NO GI Grappling *competitors can weigh-in early Friday night or Saturday morning. Venue: Monroeville Convention Center 209 Mall Boulevard Monroeville, PA Free Parking Hotel: Monroeville Convention Center Double Tree Monroeville Mall Boulevard Monroeville, PA Adjacent to convention center *Double Tree will sell out quickly, book in advance! Must mention KUMITE CLASSIC Room Block Kumite Discount rooms: $ Reservation Deadline May 10th AIRPORT: Pittsburgh International (PIT) Overflow Hotel: Holiday Inn: Kumite Discount Rooms: FRIDAY MAY 23rd Registration & Early Weigh-ins 2pm-6pm Consumer Expo 4pm-9pm SATURDAY MAY 24th BJJ Brazilian Jiu-Jitsu & NO GI GRAPPLING Registration & Weigh-ins 7:00 AM-9:00 AM Orientation on the Mat 9:00 AM BJJ Competition 9:15 AM NO GI Grappling immediately to follow FREE T-SHIRT EARLY PRE-REGISTERED COMPETITORS FREE T-shirt w/pre Registration SPECTATOR FEES: General Admission Friday $10.00 General Admission Saturday $15.00 *Competitors receive free expo admission all weekend IMPORTANT INFORMATION You may register at the door All postal Pre-Registrations or Registrations: Must be post marked by May 11th. Please do not mail any forms after this date, instead please register the day of the tournament. No sandbagging. If you have previous wrestling experience, you are not permitted to compete in the novice divisions. No refunds, please don t ask. No substitutions, please don t ask. Pre-registered competitors can pick up credentials Early weigh-ins Friday between 2:00pm-6:00pm or the day of your event starting at 7:00am Sat. We accept registrations at the door if you miss the pre-reg deadline. If you want to (cross over) and enter both Gi & No-Gi competition, you must register them both at the same time, no exceptions. Competitor entries include free general admission to the Kumite Classic for the entire weekend. Pick up your credentials on Friday and enjoy the expo at no charge with your competitor band We reserve the right to combine or create divisions to accommodate competitors. Changes are made at the discretion of the coordinator. Updated info always visit

4 BJJ & GRAPPLING DIVISIONS Please check all divisions you wish to enter: -SATURDAY: BEGINS WITH BJJ DIVISIONS NO-GI GRAPPLING TO FOLLOW Type # Age Rank Weight Division (M/F) Day BJJ belts & weight separated at ring all weights Youth Male/Female Saturday BJJ belts & weight separated at ring all weights Teen Male Saturday BJJ belts & weight separated at ring all weights Teen Female Saturday BJJ all belts separated at ring Women's Light Female Saturday BJJ all belts separated at ring 135+ Women's Middle Female Saturday BJJ White Belt Men's Feather Male Saturday BJJ Blue Belt Men's Feather Male Saturday BJJ Purple/Brown/Black Belt Men's Feather Male Saturday BJJ White Belt Men's Light Male Saturday BJJ Blue Belt Men's Light Male Saturday BJJ Purple/Brown/Black Belt Men's Light Male Saturday BJJ White Belt Men's Middle Male Saturday BJJ Blue Belt Men's Middle Male Saturday BJJ Purple/Brown/Black Belt Men's Middle Male Saturday BJJ White Belt Men's Light Heavy Male Saturday BJJ Blue Belt Men's Light Heavy Male Saturday BJJ Purple/Brown/Black Belt Men's Light Heavy Male Saturday BJJ White Belt Men's Heavy Male Saturday BJJ Blue Belt Men's Heavy Male Saturday BJJ Purple/Brown/Black Belt Men's Heavy Male Saturday BJJ White Belt 210+ Men's Super Heavy Male Saturday BJJ Blue Belt 210+ Men's Super Heavy Male Saturday BJJ Purple/Brown/Black Belt 210+ Men's Super Heavy Male Saturday BJJ all belts separated at ring Executive Light Male Saturday BJJ all belts separated at ring Executive Heavy Male Saturday BJJ all belts separated at ring 200+ Executive Super Heavy Male Saturday BJJ all belts separated at ring Masters Light Male Saturday BJJ all belts separated at ring Masters Heavy Male Saturday BJJ all belts separated at ring 200+ Masters Super Heavy Male Saturday Type # Age Rank Weight Division (M/F) Day G rank & weight separated at ring all weights Youth Male/Female Saturday G rank & weight separated at ring all weights Teen Male Saturday G rank & weight separated at ring all weights Teen Female Saturday G all ranks separated at ring Women's Light Female Saturday G all ranks separated at ring 135+ Women's Middle Female Saturday G Novice Men's Feather Male Saturday G Intermediate Men's Feather Male Saturday G Advanced Men's Feather Male Saturday G Novice Men's Light Male Saturday G Intermediate Men's Light Male Saturday G Advanced Men's Light Male Saturday G Novice Men's Middle Male Saturday G Intermediate Men's Middle Male Saturday G Advanced Men's Middle Male Saturday G Novice Men's Light Heavy Male Saturday G Intermediate Men's Light Heavy Male Saturday G Advanced Men's Light Heavy Male Saturday G Novice Men's Heavy Male Saturday G Intermediate Men's Heavy Male Saturday G Advanced Men's Heavy Male Saturday G Novice 210+ Men's Super Heavy Male Saturday G Intermediate 210+ Men's Super Heavy Male Saturday G Advanced 210+ Men's Super Heavy Male Saturday G all ranks separated at ring Executive Light Male Saturday G all ranks separated at ring Executive Heavy Male Saturday G all ranks separated at ring 200+ Executive Super Heavy Male Saturday G all ranks separated at ring Masters Light Male Saturday G all ranks separated at ring Masters Heavy Male Saturday G all ranks separated at ring 200+ Masters Super Heavy Male Saturday Information subject to change. We reserve the right to create or combine divisions to accommodate competitors. These divisions are an outline, and are subject to change at the discretion of the coordinator. *Absolute Advanced division must have a minimum of at least 4 competitors to award any prize money. There are NO REFUNDS Please don t ask. Pre-register at your own risk.

5 LIABILITY RELEASE, WAIVER, DISCHARGE AND COVENANT NOT TO SUE This is a legally binding liability release, waiver, discharge and covenant not to sue (the Release ), made by me, the undersigned, to Kumite Classic Entertainment Corp. I, (PRINT NAME CLEARLY), Fully recognize that there are dangers and risks to which I may be exposed by participating in the Kumite Classic Jiu-Jitsu and Grappling tournament, which involves strenuous physical activity and extensive physical contact with other people and a mat, including but not limited to joint locks, throws, chokes, strikes, ground wrestling, and other similar activity. I understand and acknowledge that grappling and jiu -jitsu activities in general have inherent dangers that no amount of care, caution, training, instruction, supervision or expertise can eliminate. With full understanding of the risks involved and despite this Release, I am voluntarily entering the Kumite Classic. I therefore agree to assume and take upon myself all of the risks and responsibilities in any way associated with this activity. I release Kumite Classic Entertainment Corp., its agents, volunteers, and William Viola III from any and all liability, claims and actions that may arise from injury or harm to me, from my death or from damage to my property in connection with this tournament. I acknowledge and fully understand that I will be engaging in activities that involve risk of serious injury, and that severe social and economic losses may result not only from my own action, inactions or negligence, but also from the actions, inactions or negligence of other notwithstanding the rules of play or the condition of the premises or of any equipment used. Further I acknowledge and fully understand that there may be other associated risks with such activities that are not known or not reasonably foreseeable at this time. I understand that this Release covers liability, claims and actions caused entirely or in part by any acts or failures to act by Kumite Classic Entertainment Corp., its agents, volunteers, including but not limited to negligence, mistake, or failure to supervise. I recognize that this Release means I am giving up, among other things, rights to sue Kumite Classic Entertainment Corp., its agents, and volunteers for injuries, damages, or losses I may incur while participating in this tournament. I also understand that this release binds my heirs, executors, administrators, and assigns, as well as myself. I EXPRESSLY AND VOLUNTARILY ASSUMES ALL RISK OF PERSONAL INJURY, PERMANENT, TEMPORARY, TOTAL OR PARTIAL DISABILITY, DISFIGUREMENT, PARALYSIS AND ANY OTHER LOSSES OR DAMAGES TO PERSON OR PROPERTY OR DEATH, SUSTAINED WHILE PARTICI- PATING IN THE KUMITE CLASSIC, INCLUDING THE RISK OF PASSIVE OR ACTIVE NEGLIGENCE OF THE RELEASEES, OR HIDDEN, LATENT, OR OBVIOUS DEFECTS IN THE FACILITIES OR EQUIPMENT USED. I HEREBY FOREVER RELEASE, DISCHARGE AND COVENANT NOT TO SUE KUMITE CLASSIC ENTERTAINEMNT CORP. I ACKNOWLEDGE THAT I HAVE HAD SUFFICIENT OPPORTUNITY TO REVIEW THE PROVISIONS OF THIS DOCUMENT AND UNDERSTAND ITS PURPOSE, MEANING AND INTENT. I HAVE READ THE ENTIRE RELEASE, I FULLY UNDERSTAND IT, AND I AGREE TO BE LEGALLY BOUND BY IT. THIS IS A RELEASE OF YOUR RIGHTS. READ CAREFULLY BEFORE SIGNING. Releaser s Signature Date Parent s or Guardian s Signature, if a minor (under 18) Witness

6 GI RULES SUMMARY GI DIVISIONS ARE AWARED POINTS FOR: TAKEDOWNS 2PTS. SWEEP FROM THE GUARD 2PTS. KNEE ON BELLY 2PTS. PASS GUARD TO SLIDE 3PTS REAR MOUNT 4PTS MOUNT 4PTS YOU MUST HOLD THE POSITION FOR 3 SECONDS FOR ALL WHITE BELTS, CHILD & TEEN COMPETITORS: NO ATTACKS BELOW THE WAIST (KNEE BARS, HEEL HOOKS, FOOTS LOCKS ETC.) BLUE BELTS, MASTERS, SENIORS, WOMENS: ANKLE LOCKS PERMISSABLE TWISTING ANKLE AND LEG LOCKS ARE NOT ALLOWABLE ADULT MENS PURPLE BELT AND ABOVE: STRAIGHT ANKLE LOCKS AND KNEE BARS ARE ALLOWED TOE HOLDS ARE ALLOWED, (AKA FIGURE FOUR) NO-GI RULES SUMMARY CONSCIOUSLY SUBMITTING, IT IS VERY IMPORTANT THAT ALL COMPETITIORS UNDERSTAND HOW TO TAP-OUT WHEN CAUGHT IN A SUBMISSION TECHNIQUE. TAPPING OUT CAN BE DONE PHYSICALLY OR VERBALLY DIVISIONS UNDER AGE 12, 3 MINUTES/ ALL OTHER DIVISIONS 4 MINUTES IN LENGTH. EXCEPT FOR ADULT INTERMEDIATE 5 MINUTES, & ADVANCED ADULT WHICH ARE 6 MINUTES ILLEGAL SUBMISSION TECHNIQUES: *No attacks to, eyes (elbows, palms, fingers, etc) No fish hooks, not hair pulling or biting. No pushing palm or elbow directly into nose and no excessive cross facing NO STRIKING OF ANY KIND THIS INCLUDES, HEADBUTTS PUNCHES, ELBOWS, KNEES, KICKS ETC. NO DROPPING OR SLAMMING OPPONENT ON THEIR HEAD, NO SLAMMING FROM THE GUARD POSITION FIGHTERS ARE NOT ALLOWED TO GRAB OR USE THEIR OPPONENTS CLOTHING. T-SHIRTS ARE OPTIONAL IN THE NO- DIVISIONS IF A MATCH IS CONSIDERED A DRAW (BY THE REFEREE), THEN THERE WILL BE A 2 MINUTE OVERTIME. JUDGES ARE EN- COURAGED TO CHOOSE A WINNER IN EVERY MATCH SHOULD IT NOT END BY A SUBMISSION. IF A MATCH IS DEADLOCKED, THE REFEREE MAY RE-START THE MATCH FROM A STANDING POSITION. NO-GI DIVISIONS, UNIFORM ARE NOT REQIIRED, AT A MINIMUM SHORTS WITH A DRAW STRING, A CUP AND A MOUTH PIECE MUST BE WORN. NO HEEL HOOKS OR NECK CRANKS ALLOWED IN ANY DIVISION, NO SLAMMING FROM THE GUARD ALLOWED IN ANY OF THE DIVISIONS. ANY USE OF AN ILLEGAL TECHNIQUE, ANY ACT OF POOR SPORTSMANSHIP, ANY ACT OF DISRESPECT TO THE REFEREES, TOURNA- MENT OFFICIALS OR EMPLOYEES, WILL RESULT IN IMMEDIATE EJECTION FROM THE COMPETITION AND OR PREMISES WITHOUT A REFUND. *THIS APPLIES TO ALL DIVISIONS SPECTATORS AND COACHES. IMPORTANT INFORMATION DIVISIONS ARE SUBJECT TO CHANGE DEPENDING ON THE SIZE OF THE EVENT, PARTICIPATION AND OTHER ISSUES DEEMED NECES- SARY BY TOURNAMENT OFFICIALS. WE RESERVE THE RIGHT TO REQUEST A DRIVERS LICENSE, BIRTH CERTIFICATE OR OTHER FORMS OF I.D. AT THE TIME ENTRANCE. IF YOU MISS YOUR DIVISION THERE IS NO REFUND! NAMES WILL BE CALLED 3 TIMES FOR A TOTAL OF TWO MINUTES, PLEASE BE AWARE. IN ALL DIVISIONS WE WILL MAKE THE EFFORT NOT TO MATCH PLAYERS FROM THE SAME SCHOOL, UNLESS IT IS UNAVOIDABLE, ESPECIALLY IN THE NO-GI DIVISIONS. ALL ERRORS MUST BE CORRECTED BEFORE THE MATCH BEGINS, NO EXCEPTIONS. REFEREES HAVE THE RIGHT TO CALL A MATCH FOR ANY REASON HE/SHE SEES FIT, SUCH AS UNSPORTSMAN LIKE CONDUCT, UNSAFE TECHNIQUES, DISRESPECT TO THE OFFICIALS ETC., THIS APPLIES TO COMPETITORS, SPECTATORS AND PAR- ENTS NO ONE WILL BE ALLOWED TO ENTER OR PARTICIPATE IF HE/SHE IS SUSPECTED TO BE UNDER THE INFLUENCE OF DRUGS OR ALCOHOL. GENERAL CLEANLINESS EXPECTED, ARRIVE WITH CLEAN ATTIRE AND NO OFFENSIVE ODORS. NO ONE WITH INFECTIOUS DISEASED PERMITTED TO COMPETED, INCLUDING BUT NOT LIMITED TO RINGWORM, STAPH, HERPES ETC. HE PROMOTER AND OFFICIALS HAVE THE RIGHT TO REFUSE ANY ENTRY TO THIS EVENT. PLEASE BE DILIGENT WHEN FILLING OUT YOUR REGISTRATION FORMS, MOST CONFUSION DURING TOURNAMENTS BEGIN WITH AN IMPROPERLY COMPLETED FORM. BE SURE TO INCLUDE ALL REQUESTED INFO AND PRINT LEGIBLY. *WE RESERVE THE RIGHT TO CHANGE OR UPDATE ANY OF THIS INFORMATION. ALL RULES ARE SUBJECT TO THE DISCREATION OF THE COORDINATOR. PLEASE ATTEND THE RULES ORIENTATION AT THE BEGINNING OF THE TOURNAMENT (Based on PBJJF Rules). MARTIAL ARTS IS BASED ON RESPECT: ALL MATCHES SHOULD BEGIN AND END WITH A HANDSHAKE, PROMOTING THE SPIRIT OF GOOD SPORTSMANSHIP!

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