2011 SKIF-USA and USF
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2 2011 SKIF-USA and USF -National Team Trials and Open Division- Kata and Kumite Registration Form Name: Age: Sex: Rank: Length of Training: Years Months Mailing Address: Street City State Zip Address: Instructor: _ Dojo: Phone: Martial Arts Style: Division Kata: Kumite: I, THE UNDERSIGNED, STATE: I have been advised that my participation in the 2011 SKIF USA Open Division U.S. Nationals will expose me to a risk of serious personal injury including permanent disability and death. I am aware of this potential danger, and with full knowledge of this risk, voluntarily accept and assume the risk of injury by signing this RELEASE and by participating in these activities. Further, and in exchange for my participation in the 2011 SKIF USA Open Division U.S. Nationals. I, on behalf of myself and my successors, assigns, and heirs, release SKIF USA, Shockness Shotokan and any of its sponsors, donors, owners, directors, and officers, agents, employees, members, volunteers, and representatives from any and all liability from injury, damage or loss to person, persons, or property based upon their negligence in connection with my participation in this competition. I further agree to indemnify and to hold harmless SKIF USA, Shockness Shotokan and any of its sponsors, donors, owners, directors and officers, agents, employees, members, volunteers and representatives from any and all claims made against them arising from participation in this competition. I fully understand that any medical treatment given will be of a first aid treatment type only. I consent that any pictures taken of me in connection with the competition can be used for publicity, promotion or television shown now or in the future, and I waive compensation in regard thereto. All participants in any event or class in this competition is by permission only. The Director or authorized agents reserve the right to refuse entry to any person, school, team or club. I have read this CONSENT and RELEASE, understand the meaning of its content, and sign it voluntarily. Signature of Competitor For the MINOR Student: I,, am the parent or legal guardian for. I have read the above CONSENT to my child s participation in the 2011 SKIF USA Open Divisions US Nationals, under the terms and conditions above. With my signature, I hereby release 2011 SKIF USA Open Divisions US Nationals of any and all liabilities. Signature of Parent or Guardian _ Fees: One individual event: $50; Two individual events: $60 One individual event at the door: $60; Two individual events at the door: $70 Spectator Fee: $5 Pre-register by: Check or Money Order before September 1 st, 2011 At Door: CASH ONLY, PLEASE! Make checks payable to: Wayne Shockness
3 Hotels SKIF-US Team Open Championships General Information Hotel Kabuki Room rate: $169 plus tax Best Western: Hoteltomo Room rate: $149 plus tax All prices are good until August 15 th. Both hotels reservations contact information: Telephone: Tournament and Seminar Location Bakar Fitness & Recreation Center at UCSF Mission Bay 1675 Owen Street San Francisco, CA Telephone: Tournament and Seminar fees Make checks or money orders payable to Wayne Shockeness 679 Pine Street Apt. 5 San Francisco, CA All pre-registration must be before September 1 st. After September 1 st, late fees will apply. Seminar fees One session: $50 Two sessions: $80 Pre-registration is same price. Tournament fees, pre-registration: $50 one event $60 two events $70 three events $80 four events After September 1 st, 2011 or at the door Tournament Registration fees: $60 one event $70 two events $80 three events $90 four events
4 All proceeds will go to benefit all tsunami victims in Japan. Tournament Basic Rules Gloves and mouthpiece are mandatory for all competitors. Groin cups are mandatory for men. Headgear is required for all competitors for under the age of 18. Headgears for Adults are optional. NO FOOD ALLOWED IN THE GYM. WATER ONLY. Awards will be given to the dojo with the most wins. First, second, and third open non-skif schools. SKIF USA or USF members will be placed first, second, and third most winning schools. All SKIF rules will be strictly enforced at this tournament. All SKIF members competing in the National Team Trials will be automatically registered in the open divisions. There will be grand champion kata and grand champion kumite winners. All black belt first place adult divisions qualify. Thank you very much, Charles Baker-sensei
5 SKIF-US Open National Championships -Seminar Form- I, THE UNDERSIGNED, STATE: I have been advised that my participation in the 2011 SKIF USA Open Division U.S. Nationals will expose me to a risk of serious personal injury including permanent disability and death. I am aware of this potential danger, and with full knowledge of this risk, voluntarily accept and assume the risk of injury by signing this RELEASE and by participating in these activities. Further, and in exchange for my participation in the 2011 SKIF USA Open Division U.S. Nationals. I, on behalf of myself and my successors, assigns, and heirs, release SKIF USA, Shockness Shotokan and any of its sponsors, donors, owners, directors, and officers, agents, employees, members, volunteers, and representatives from any and all liability from injury, damage or loss to person, persons, or property based upon their negligence in connection with my participation in this competition. I further agree to indemnify and to hold harmless SKIF USA, Shockness Shotokan and any of its sponsors, donors, owners, directors and officers, agents, employees, members, volunteers and representatives from any and all claims made against them arising from participation in this competition. I fully understand that any medical treatment given will be of a first aid treatment type only. I consent that any pictures taken of me in connection with the competition can be used for publicity, promotion or television shown now or in the future, and I waive compensation in regard thereto. All participants in any event or class in this competition is by permission only. The Director or authorized agents reserve the right to refuse entry to any person, school, team or club. Please check Session One or Session Two: Session One Session Two ***Pricing: Participation in one session will be $50. Participation in two sessions will be $80.*** I have read this CONSENT and RELEASE, understand the meaning of its content, and sign it voluntarily. Signature of Participant If Under Age 18, Signature of Parent or Guardian
6 I, THE UNDERSIGNED, STATE: SKIF-US Open National Team Kumite -Waiver Form- I have been advised that my participation in the 2011 SKIF USA Open Division U.S. Nationals will expose me to a risk of serious personal injury including permanent disability and death. I am aware of this potential danger, and with full knowledge of this risk, voluntarily accept and assume the risk of injury by signing this RELEASE and by participating in these activities. Further, and in exchange for my participation in the 2011 SKIF USA Open Division U.S. Nationals. I, on behalf of myself and my successors, assigns, and heirs, release SKIF USA, Shockness Shotokan and any of its sponsors, donors, owners, directors, and officers, agents, employees, members, volunteers, and representatives from any and all liability from injury, damage or loss to person, persons, or property based upon their negligence in connection with my participation in this competition. I further agree to indemnify and to hold harmless SKIF USA, Shockness Shotokan and any of its sponsors, donors, owners, directors and officers, agents, employees, members, volunteers and representatives from any and all claims made against them arising from participation in this competition. I fully understand that any medical treatment given will be of a first aid treatment type only. I consent that any pictures taken of me in connection with the competition can be used for publicity, promotion or television shown now or in the future, and I waive compensation in regard thereto. All participants in any event or class in this competition is by permission only. The Director or authorized agents reserve the right to refuse entry to any person, school, team or club. I have read this CONSENT and RELEASE, understand the meaning of its content, and sign it voluntarily. Team Name Signature of Participant 1 Signature of Participant 2 Signature of Participant 3
7 SKIF-US Open Nationals -Open Divisions for All Participants- -Registration Form- Kata and Kumite Divisions Please check the kata and/or kumite division that you would like to participate in: Kata Division Kumite Division Group by Age and Sex K1 S1 5-6 Boys and Girls K2 S2 7-8 Boys Beginner K3 S3 7-8 Boys Intermediate K4 S4 7-8 Boys Advanced K5 S5 7-8 Girls Beginner K6 S6 7-8 Girls Intermediate K7 S7 7-8 Girls Advanced K8 S Boys Beginner K9 S Boys Intermediate K10 S Boys Advanced K11 S Girls Beginner K12 S Girls Intermediate K13 S Girls Advanced K14 S Boys Beginner K15 S Boys Intermediate K16 S Boys Advanced K17 S Girls Beginner K18 S Girls Intermediate K19 S Girls Advanced K20 S Boys Beginner K21 S Boys Intermediate K22 S Boys Advanced K23 S Girls Beginner K24 S Girls Intermediate K25 S Girls Advanced K26 S Boys Beginner K27 S Boys Intermediate K28 S Boys Advanced K29 S Boys Black Belt K30 S Girls Beginner K31 S Girls Intermediate K32 S Girls Advanced K33 S Girls Black Belt K34 S Boys Beginner K35 S Boys Intermediate K36 S Boys Advanced K37 S Boys Black Belt K38 S Girls Beginner K39 S Girls Intermediate K40 S Girls Advanced K41 S Girls Black Belt K42 S Men's Open Beginner K43 S Men's Open Intermediate K44 S Men's Open Advanced K45 S Women's Open Beginner K46 S Women's Open Intermediate K47 S Women's Open Advanced K48 S48 40 and up Men's Open Beginner
8 K49 S49 40 and up Men's Open Intermediate K50 S50 40 and up Men's Open Advanced K51 S51 40 and up Women's Open Beginner K52 S52 40 and up Women's Open Intermediate K53 S53 40 and up Women's Open Advanced K54 S Men s Black Belt wt (-60 kg) K55 S Men s Black Belt wt (-75 kg) K56 S Men s Black Belt wt (+75) K57 S Women s Black Belt wt (-60 kg) K58 S Women s Black Belt wt (+60 kg) K59 S Men s Black Belt K60 S Women s Black Belt K61 S61 50 and Older Men s Black Belt K62 S62 50 and Older Women s Black Belt We reserve the right to combine divisions that have less than three competitors in a division.
9 SKIF-USA and USF Members Only -National Team Trials for Brown and Black Belts Only- - Registration Form- Kata and Kumite Divisions Please check the kata and/or kumite division that you would like to participate in: Kata Division Kumite Division Group by Age and Sex K70 S Boys K71 S Girls K72 S Boys K73 S Girls K74 S Boys K75 S Girls K76 S Boys K77 S Girls K78 S Boys K79 S Girls K80 S Men wt (-65 kg) K81 S Men wt (-75 kg) K82 S Men wt (+75 kg) K83 S Women wt(-60 kg) K84 S Women wt(+60 kg) K85 S Men K86 S Women K87 S Men K88 S Women First Name: Last Name: Dojo: SKIF Membership Number: Instructor: ***All participants registering for National Team Trials will be registered free of charge for the Open Divisions.***
SENSEI MARY CRAWFORD. There will NOT be any onsite registration for competition at either event.
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