Competition Dates: Saturday May 29, 2010, 2:30 pm Senior White, Brown, Black Belt, Masters and IJF Junior: Sunday, May 30, 2010, 9:00 am Bantam Jr. Bantam, Intermediate A and B, Juvenile A and B Juvenile B has been moved to Sunday Spectator Fees $7.00 per day or $10 for both days No admission fee for children 12-years of age and under, accompanied by an adult. Tickets available at the CCSF Box Office the day of the tournament. General Information www.caljudoinc.com Event:, May 29-30, 2010 Venue: Host: Tournament Headquarters: Transportation: City College of San Francisco Wellness Center City College of San Francisco Judo Club and Central Coast Judo Association The Westin San Francisco Airport 1 Old Bayshore Highway, Millbrae, Ca., Phone: 888.627.8404 Room Rates $95 for single or double/$115 for triple and quad per night. Please mention 2010 California State Judo Tournament. Deadline for room reservation: May 6, 2010 Airport Transportation to Hotel: Airport (SFO) shuttle runs every 20 minutes to the Westin Airport Hotel. In addition, the Hotel offers free shuttle to Bay Area Rapid Transit (BART) Service to San Francisco Bay Area Sanction: USJF #10-05-12 Tournament Director: Registration Chairperson: Head Referee: Tournament Officials Mitchell Palacio - mtpalacio@msn.com Trina Chinn - tsc337@gmail.com Gary Takemoto Page 1 of 15 (rev.4)
Eligibility 1. Contestants must be current members of at least one of the following organizations and have current insurance coverage with that organization in force on the day of competition: United States Judo Federation, Inc. (USJF), USA Judo (USJI), or United States Judo Association (USJA) and live in California. Only USJF Registration will be provided on site. No age waivers will be considered or accepted INFORMATION FOR ALL COMPETITORS SPECIAL NOTES 1. All competitors are expected to behave appropriately. Any misconduct at the HOTEL, tournament site, tournament headquarters, or elsewhere in connection with this competition will be grounds for automatic disqualification from this tournament. 2. There will be NO REFUND OF FEES. 3. All contestants, their parents, legal guardians, coaches, and instructors will be held personally responsible for any personal or property damage incurred due to misconduct. The CJI Tournament Committee, which will include the CJI President and the Chairs of the Standards Committee and Development Subcommittee have the right to make any changes necessary for the betterment of the tournament. Awards Awards will be given for First, Second and Third place in each division. Team Awards will be presented to 1 st Place Team, 2 nd Place Team, 3 rd Place Team Registration Information Mail completed registration with payment and all applicable forms to 2010 Trina Chinn 2717 21 st Street San Francisco, CA 94110 Proof of Age is required for all contestants. Acceptable forms include birth certificate or passport, a USA Judo membership card with a V next to the birth date, California ID or California Drivers License. Copy of current national memberships (USJA, USJF, USA Judo) will be required. We have arranged two options, to accommodate local competitors who will compete in the Senior White, Brown, Black Belt, Juvenile B and IJF Junior, on Saturday, May 29, 2010, Registration and Weigh-in, Friday, May 29 from 7:00 pm to 10:00 pm for ONLY Senior White, Brown, Black Belt, Juvenile B And IJF Junior 2 nd opportunity to register will be on Saturday morning, 8:00 am to 10:00 am. Registration for Saturday competition will close at 10:00 am. Page 2 of 15 (rev.4)
MAIL-IN REGISTRATION REQUIREMENTS: Mail-in Pre-Registration POSTMARKED on or BEFORE Friday, May 7,010 Mail-in Late Registration POSTMARKED AFTER Friday, May 7th. The non-refundable entry fee must accompany the official entry form with the required documents. Personal checks, cashier s checks or money orders are acceptable. A $30.00 fee will be charged for all returned checks. Absolutely NO entries will be received after Friday, May 21, 2010 cutoff date. Entry will be considered as Walk-up Registration. Pre-Registered and Walk up Contestants: Friday, May 28, 7:00 pm to 10:00 pm (For individuals arriving on Friday Night and competing on Sat.) ****(Only For Competitors Competing On Saturday)**** o 1 st Opportunity for: Senior White, Brown, Black Belts, and IJF Junior Saturday, May 29, 8:00 AM TO 10:00 AM at the Tournament Headquarters. o Registration for Sat. Afternoon Competitors will Close at 10:am. 2 ND Opportunity for: Senior White, Brown, Black Belts, and IJF Junior Saturday, May 29, 8:00am to 4:00pm at the Tournament Headquarters. o All Contestants Competing on Sunday, May 30, 2010 NO ENTRY WILL BE ACCEPTED AFTER 4:00 PM SATURDAY, MAY 29. Pre-Registered and Walk Up Contestants Check-In: Check-In: Upon arrival at the tournament headquarters, pre-registered contestants report directly to the Ballroom for check-in. Competitors must present their proof of identification and actual USJF, USJA, or USJI card (show proof of insurance). Those without a valid card will be required to purchase one at that time. Once checked-in, report to the weigh-in areas: Females Weigh-In - Report to the Laurel Room Males Weigh-In - Report to the Oak Room Fees All checks should be made payable to: ML Event Management During walk-up registration only Cash, Money orders or travels checks will be accepted. Incomplete registrations must be corrected before the deadlines to be considered on time. Event Pre-Registration Postmarked BEFORE May 7, 2010 Late Registration Postmarked AFTER May 7, 2010 NO entries will be received after Friday, May 21, 2010 Walk-up Registration At Host Hotel Check in no later than 4pm on May 29, 2009 Individual Competition $60 $80 $100 2 competitors from the same Family* $90 $130 $175 3 competitors from the same family* $130 $190 $220 4 competitors from the same family* $150 $220 $250 Coaches badges FREE (up to 6) $25 $50 * To receive family discount all entries must be received at the same time. Page 3 of 15 (rev.4)
Rules Juniors Seniors Current modified Pre 1994 IJF Contest Rule regarding safety zone and out of bounds area. This tournament will use the Pre 1994 IJF contest rules regarding safety zone and out of bounds area, which permits reduction of safety areas and the common safety areas when two or more competition areas are utilized. (2.5 meters (8 2 ) safety area and 3 meters (9 8 ) for common areas.) Shime-waza (chokes): allowed in 13 yrs and older Kansetsu-waza (armlocks): allowed in IJF Junior 3 minutes match length: Bantam Jr., Bantam, Intermediate A and B, Juvenile A 5 minutes match length: Juvenile B and IJF Junior Shime-waza (chokes): allowed in all senior divisions Kansetsu-waza (armlocks): Only allowed in Senior Black belt divisions. 3 minutes match length: All division except Black Belts 5 minute match length: Black belt divisions Injury Rule Decisions as to whether an athlete may continue if injured while on the mat, are to be resolved in accordance with IJF rules. Match Numbering System Pools will be posted (Hotel and Venue) as soon as possible after the close of designated weigh-ins. (Coaches please check the draw sheets to make sure your players are in their correct brackets) Competitors are required to report to the match 3 matches before their number. Method of Competition for Juniors Judo Gis Divisions with six (6) competitors or more: Straight double elimination system. Divisions having five (5) competitors or less: Round Robin Pool. Every competitor will compete against everyone in their respective pool. Winner will be determined by number of wins. o Tie breakers o Head to Head Competition o Points based on level of win. Ippon=10, waza-ari=7, yuko=5, no-score decision=1 o Round- Robin showdown Judo belts and Gi color: The wearing of a Blue judo gi by the Blue Side Competitor is mandatory for athletes in the IJF Youth categories. For competitors in the other categories blue gi s are optional. The white side competitor must wear a white judo gi. Competitors are responsible for appearing in the correct color gi. Under no circumstances shall both competitors be allowed to compete in blue judogis, nor will the blue and white competitors be allowed to switch positions. The gi jacket and pants must be the same color - no mixing of colors. In all matches where the both competitors are wearing white judogis, both competitors will remove their grade belts and wear a blue or white belt to identify the contestant s designated color for the match. SHIAI COMPETITORS MUST SUPPLY THEIR OWN WHITE AND BLUE BELTS Page 4 of 15 (Rev. 4)
Categories and Weight Divisions The Age/Weight divisions are listed on the next page. All junior categories are based solely on the year the contestant was born. The age of the contestant on the day of competition is irrelevant. Contestants will not be permitted to enter a division they do not qualify to compete in according to age and weight, except for Juvenile B competitors may also (or instead of) compete in the IJF Junior and/or the Senior Division. IJF Junior Competitors may choose also (or instead of) choose to compete in the senior division. Uncontested players may elect to move up either to the next older division or the next higher weight division (Requires approval of parent or guardian.) Players and parents will not be notified, but will be moved in accordance with the age/ weight change form. In the event a contest moves up to the next older division, they will compete under the rules of the older division. All contestants competing on Sunday must be register and Weighed in by 4:00 pm Saturday, May 29, 2010. THERE WILL BE NO WEIGH-INS ON SUNDAY OF COMPETITION. Junior Weight Divisions Junior Male Category Year Born All weights in Kilograms Bantam Jr. 2005 19 23 28 28+ Bantam 1 2004 19 23 28 28+ Bantam 2 2003 21 25 30 30+ Bantam 3 2002 23 27 31 35 35+ Intermediate A 2000-2001 26 30 34 38 43 43+ Intermediate B 1998-1999 28 31 34 38 42 48 53 53+ Juvenile A 1996-1997 36 40 44 48 53 58 64 64+ Juvenile B 1994-1995 51 55 60 66 73 81 90 90+ IJF Junior 1991-1993 55 60 66 73 81 90 100 100+ Open Junior Female Category Year Born All weights in Kilograms Bantam Jr. 2005 19 23 28 28+ Bantam 1 2004 19 23 28 28+ Bantam 2 2003 21 25 30 30+ Bantam 3 2002 23 27 31 35 35+ Intermediate A 2000-2001 26 30 34 38 43 43+ Intermediate B 1998-1999 28 31 34 38 42 48 53 53+ Juvenile A 1996-1997 36 40 44 48 53 58 64 64+ Juvenile B 1994-1995 40 44 48 52 57 63 70 70+ IJF Junior 1991-1993 44 48 52 57 63 70 78 78+ Open Page 5 of 15 (Rev. 4)
Senior Weight Divisions Method of Competition for Senior Black Belts: Straight Double Elimination Senior Black Belt Divisions Category Age All weights in Kilograms Senior Male Black Belt 17+ 55 60 66 73 81 90 100 100+ Open Senior Female Black Belt 17+ 44 48 52 57 63 70 78 78+ Open New Competitive System To maximize the competitive experience Method of Competition for Senior White, Brown Belts and Sr. Masters: Pool System Different Weight Classes have been instituted for a fair and balance competitive system. Maximum Pool size: 6 persons. Example: If there are 12 competitors in the 73 kg. Male White Belt Division. The division will be divided into two divisions of two, 6 person pools. Senior Masters Division: Pool Eliminations System will be used for each division. Brown and Black bets may be combined. Category Age All weights in Kilograms Senior Male 30 yrs + 55 60 66 73 81 90 100 100+ Senior Female 30 yrs + 44 48 52 57 63 70 78 78+ Senior Brown Belt Division: Pool Eliminations System will be used for each division Category Age All weights in Kilograms Senior Male Brown Belt 17+ 55 60 66 73 81 90 100 100+ Senior Female Brown Belt 17+ 44 48 52 57 63 70 78 78+ Senior Novice Division: Pool Eliminations System will be used for each division Category Age All weights in Kilograms Senior Male White, Yellow and Green Belt 17 Senior yrs and Female Older White, Yellow and Green Belt 17 yrs and Older 17+ 55 60 66 73 81 90 100 100+ Open 17+ 44 48 52 57 63 70 78 78+ Open The tournament directors reserve the right to make adjustments as necessary in the best interest of the safety of the competitors. Page 6 of 15 (Rev. 4)
Schedule of Events Friday May 28, 2010 Tournament Headquarters The Westin San Francisco Airport 7:00 pm 10:00pm Registration, Walk-up registration and Weigh-in for ONLY Saturday Competition: Senior White, Brown, Black Belt, Juvenile B and IJF Junior. All other contestants must register on Saturday, May 29 7:00 pm 10:00pm CJI State Meeting: City College of San Francisco Wellness Center, Rm 321 Saturday May 29, 2010 All activities at the Tournament Headquarters The Westin San Francisco Airport 7:00 am to 8:00 am Unofficial weigh in room (Laurel and Oak Room) 8:00 am - 10:00 am 2 nd Opportunity: Registration, Walk up registration and Weigh in for Saturday Competition: Senior White, Brown, Black Belt, and IJF Junior. Registration for Sat. Afternoon Competitors will Close at 10:am. 8:00 am 4:00 pm Tournament check-in and walk up registration for all competitors, coaches, referees and officials. Official Weigh-in Bantam Jr. Bantam, Intermediate A and B, Juvenile A and B (Laurel and Oak Room) Saturday May 29, 2010 All activities at the City College of San Francisco Wellness Center 12:30 pm to 1:00 pm Coach Meeting: Room 321 1:00 pm to 2:00 pm Referee s Meeting: Room 321 1:30 pm Match Cards Ready: Main Gym. 2:30 pm Competition begins for Senior White, Brown, Black Belt, and IJF Junior Sunday May 30, 2010 All activities at the City College of San Francisco Wellness Center 7:30 am to 8:30 am Referee s Meeting: Room 103 8:00 am Match Cards Available in Main Gym 8:30 am Assemble for Parade of Officials and All Athletes: Martial Arts Room 9:00 am Opening Ceremonies 9:30 am Competition: Bantam Jr. Bantam, Intermediate A and B, Juvenile A and B Page 7 of 15 (Rev. 4)
OFFICIAL INDIVIDUAL COMPETITION ENTRY FORM Circle the Category Junior Divisions (Only juvenile B contestants may optionally select the IJF Youth category) Bantam Jr. Bantam 1 Bantam 2 Bantam 3 Inter. A Inter. B Juv. A Juv. B 2005 2004 2003 2002 2000-2001 1998-1999 1996-1997 1994 1995 IJF Junior 1991-1993 Enter approximate weight in Kilos: Gender (Circle One): Male Female [ ] Check here if you are a White or Yellow belt Senior Divisions Senior: White, Yellow and Green Belt Senior: Brown Senior: Black Belt Senior: Masters Enter approximate weight in Kilos: Gender (Circle One) Male Female Contestants First Name: Please Print Clearly Last Name Street Address: City: State: Zip: Country: Telephone: Date of Birth: (MM/DD/YYYY) Judo Rank: Email Address: National Organization Membership Number: Expiration Date: (MM/DD/YYYY): Parents/Legal Guardian First Name: Parent/Legal Guardian Last Name: Club Name: Name of Judo Instructor/Coach: If a division has only one or two contestants, they may move up a weight division in the same age category. Juvenile B contestants have the option to compete in the IJF Youth category in addition to, or instead of their own weight division. If the contestant is less than 18 years of age a parent or legal guardian must sign the proper forms. No exceptions! All forms must be completed and attached to the Entry Form. Please use the check-off list of items to ensure you send in a complete Registration Packet. Page 8 of 15 (Rev. 4)
WARNING! WAIVER AND RELEASE OF LIABILITY AND AGREEMENT TO PARTICIPATE 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., Central Coast Judo Yudanshakai, Inc., California Judo, Inc., San Francisco Community College District, City College of San Francisco, City College of San Francisco Physical Education Department, and the City College of San Francisco Judo Club, 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., Central Coast Judo Yudanshakai, Inc., California Judo, Inc., San Francisco Community College District, City College of San Francisco, City College of San Francisco Physical Education Department, and the City College of San Francisco Judo Club, 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. 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 Date 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 Date Page 9 of 15 (Rev. 4)
MEDICAL RELEASE AND CONSENT TO THE TREATMENT OF A MINOR If the Participant is under the age of 18 years, the signature of a Parent or Legal Guardian is required. Contestant's Name (Last) (First): (MI): Address: City: State: Zip: Day Phone: ( ) Eve. Phone: ( ) Parent(s)/Legal Guardian(s): Emergency Phone: ( ) I,(we), the undersigned parent(s)/legal guardian(s) of, a minor, do hereby authorize California Judo Inc., United States Judo Federation., Its Tournament Directors, Referee Director, and Any and All Organizers, Promoters, Officers, Staff, Referees, Tournament Workers and Volunteers of the 2010, hereafter referred to as the "CHAMPIONSHIPS", as agent(s) for the undersigned to consent to any x-ray examination, anesthetic, medical or surgical diagnosis, or treatment and hospital care which is deemed advisable by, and is to be rendered under the general or special supervision of any physician and surgeon, licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. PLEASE INITIAL It is understood that this authorization is given in advance of any specific diagnosis, treatment of hospital care being required, but is given to provide authority and power on the part of our aforesaid agent(s) to give specific consent to any and all such diagnosis, treatment or hospital care which the aforementioned physician, in the exercise of his best judgment, may deem advisable. PLEASE INITIAL This authorization is given pursuant to provisions of the Civil Code of California and shall remain in effect until May 30, 2010, unless sooner revoked in writing and delivered to said agent(s). PLEASE INITIAL It is understood that the parent(s)/guardian(s) of are responsible for all costs that may be incurred as a result of the diagnosis, treatment or hospital care while traveling to or competing in the CHAMPIONSHIPS. It is also understood that the CHAMPIONSHIPS/agent(s) will contact the parent(s)/guardian(s) at the first opportunity available, but will have the welfare of the injured minor as a first priority. In the event that the parent(s)/guardian(s) are unable to make decisions concerning the need for medical diagnosis, treatment or hospital care, either a CHAMPIONSHIPS official or, in the event of a life or death threatening situation, a proper authority (police, fire, rescue, medical, etc.) will be authorized to give consent for diagnosis, treatment or hospital care. PLEASE INITIAL The undersigned has carefully read and voluntarily signed the MEDICAL RELEASE AND CONSENT TO THE TREAMENT OF A MINOR form, and further agrees that no oral representations, statements, or inducements apart from the foregoing written have been made; and that the undersigned understands that this contract constitutes a MEDICAL RELEASE AND CONSENT TO THE TREATMENT OF A MINOR. PLEASE INITIAL Participant Name (please print) Participant's Signature Date Parent/Legal Guardian (please print) Parent/Legal Guardian 's Signature Date Page 10 of 15 (Rev. 4)
POWER OF ATTORNEY Must be signed by Parent/Legal Guardian(s) of any contestant under the age of 18 not accompanied by a Parent/Legal Guardian at the 2010 I, (we), the parent(s)/legal guardian(s) of (Initial) (Contestant) will be attending these Championships. Therefore, the signature of the contestant's Parent(s)/Legal Guardian(s) is not required. I, (we), the parent(s)/legal guardian(s) of (Initial) (Contestant) will NOT be attending these Championships, and have made, constitute and appoint, person and that he/she shall deem proper or advisable, intending hereby to vest in him/her, irrevocable and full power and authority to do and perform all and every act and thing whatsoever requisite and necessary to be done in connection with the Contestant participating in the 2010 California Judo Championships, registering for events, receiving medical treatment and make any other decisions as I (we) might or could make or do if personally present. (Parent(s)/Legal Guardian(s) and witness signature required). Parent/Legal Guardian Signature Date Witness Signature Date ******************************************************************* Please fill-out if you are NOT a Black Belt and request to Compete in the Black Belt Division CERTIFICATE REGARDING CONTESTANT'S ABILITY I, a Judo Instructor, who has been awarded the Judo rank of Shodan or higher under the auspices of one of the following organizations, United States Judo Federation, United States Judo Association or United States Judo, Inc., hereby certify that the above contestant, although not having been awarded the Judo rank of Shodan or higher, is of sufficient aptitude and skill in Judo to compete in these Championships. Signature of Judo Instructor Date PLEASE PROVIDE COPY OF YOUR INSTRUCTOR'S BLACK BELT CERTIFICATE Page 11 of 15 (Rev. 4)
CONSENT FOR COMPETITION BRACKET CHANGE Must be signed by Parent(s)/Legal Guardian(s) of any contestant under the age of 18. We (I), the undersigned parent(s)/legal guardian(s) of (contestant), have been informed of the age and weight classes for competition in the 2010. In addition, #1 or #2 must also be checked according to the above provisions. Please read and sign. 1. We (I), hereby express our consent and approval that, (Initial) (Contestant) a. may move up to the next higher weight division in the same age category if their original division has only one or two competitors. b. may move up to the next higher age division in if their original division has only one or two competitors. (This does not apply to Juvenile A Competitors or IJF Competitors) c. being in the Juvenile B, may also compete in IJF Junior or Senior category (Requires additional entry fee), or compete in the IJF Junior or Senior category instead of their own age category. d. being in the IJF Youth, may also compete in senior category (Requires additional entry fee), or compete in the SENIOR category instead of their own age category. 2. We (I), DO NOT CONSENT to a change in age/weight bracket For under any circumstances. (Print contestant's name) I understand by selecting this option, the contestant might be uncontested, and will not have any matches. Parent/Legal Guardian signature: Date: Page 12 of 15 (Rev. 4)
APPLICATION FOR COACH'S BADGE Coach Badges will be given at Registration at Host Hotel on May 29, 2010 NO COACH BADGES WILL BE GIVEN OUT AT TOURNAMENT SITE. This completed application, Coach s Certification document, postmarked by May 7, 2010 for your free coach pass. Additional fees will pertain for Late Application. See Fees Section. The number of coaches will be determined by the number of registered competitors. The maximum number of coaches per dojo will be 6. DOJO COACHES Club: Head Instructor: 1st Coach's Name: 2nd Coach's Name: Certified by: USJA / USJF / USA Judo Membership# Certified by: USJA / USJF / USA Judo Membership# 3 rd Coach's Name: Certified by: USJA / USJF / USA Judo Membership# 4 th Coach's Name: Certified by: USJA / USJF / USA Judo Membership# 5 th Coach's Name: Certified by: USJA / USJF / USA Judo Membership# 6 th Coach's Name: Certified by: USJA / USJF / USA Judo Membership# ONLY AUTHORIZED COACHES WITH 2010 California State Championships COACH Wrist Band WILL BE ALLOWED IN COMPETITION AREA. There will be only one (1) coach per contestant during the competition. Page 13 of 15 (Rev. 4)
Official Event Tee-Shirt Order Form We recommend you order your Official 2010 California State Championships tee-shirt, a limited supply of sizes will be will be available for purchase at the Tournament on day of the tournament. DEADLINE: TO GUARANTEE YOUR NAME PRINTED ON THE T-SHIRTS ARE MAY 7, 2010. No Exceptions. Your tee-shirt order can be picked up at the tournament headquarter hotel on Saturday, May 29, 2010. Please remember to bring your t-shirt receipt. Name Shirt Order Reserved Under: (PLEASE PRINT YOUR NAME LEGIBLE AS IT WILL BE PRINTED ON THE T-SHIRTS) First Name: Last Name: Mailing Address: Phone Number: City: Zip: Size Quantity Price Total Youth Small $15.00 $ Youth Medium $15.00 $ Adult Small $15.00 $ Adult Medium $15.00 $ Adult Large $15.00 $ Adult XL $15.00 $ Adult 2X $18.00 $ Adult 3X $18.00 $ Total Shirts Send this form along with check payable to ML Event Management Official 2010 CJI Championship Tee-Shirt to the address below: 2010 California State Championships c/o Trina Chinn, Registration Chair 2717 21 st Street San Francisco, CA 94110 Page 14 of 15 (Rev.4)
CHECK LIST Please place a check mark by all that you have submitted. Please note that numbers 1-11 are mandatory items. Mandatory Forms 1. [ ] Official Entry Form - one must be completed for EACH category entered. 2. [ ] Warning, Waiver and Release of Liability and Agreement to Participate - signed by Contestant and Parent(s) or Legal Guardian(s) of contestants under age 18. 3. [ ] Copy of National Membership Card - current USJF, USJA or USJI card or proof of current membership of foreign National Federation and proof of medical insurance. 4. [ ] Proof of Age - copy of a government issued birth certificate or passport or government issued identification or driver s license. A baptismal record, school ID, and etc. is not proof of age! 5. [ ] Entry fee: Check made out to ML Event Management. Personal check, money order, traveler s check, or cashier s check only (NO CASH please) Money order, cashier s check, travelers check, or cash (NO PERSONAL CHECKS will be accepted) (FOR ANY LATE REGISTRATION) 6. [ ] Copy of Black Belt Certificate if competing in Black Belt Division. 7. [ ] Medical Release and Consent to the Treatment of a Minor - signed by Contestant and Parent (s) or Legal Guardian(s) of contestants under 18 years of age. 8. [ ] Power of Attorney 9. [ ] Certificate Regarding Contestant s Ability if Competing in the Black Belt Divsion- signed by judo instructor. 10. [ ] Consent for Competition Bracket Change - signed by Parent(s)/Legal Guardian(s) of contestants under 18 years of age. 11. [ ] Coach Badge Application 12. [ ] T-Shirt form & payment 13. [ ] Confirmation of Registration - email address noted on Entryform. Page 15 of 15 (Rev.4)