Hosted by: RPI Judo Club Sanctioned by: United States Judo Association 10-028 Date: Saturday, April 30th, 2011 RPI s Annual Spring Judo Tournament Location: Registration: Eligibility: Entry Fee: Late Fee: Awards: Scoring: Rules: Contacts: Food: Head Referee: Rensselaer Polytechnic Institute Robison Gym, The Armory, 15 th St. Troy, NY 12180 Juniors -12 8:00-9:30 12-16 8:00-9:30 Seniors and Masters 17+ 8:00-11:00 Each competitor must present a current USJI, USJF, USA Judo, or USJA card at registrations. USJA applications will be available at the site. You must have a form of identification to register on site (NO EXCEPTIONS!) $30.00 for the first division. Additional $10.00 for a second division. Make checks payable to RPI Judo Club. $10.00 if postmarked after 4/22/2011 (NO EXCEPTIONS!) 1 st, 2 nd, and 3 rd place awards for each division. True double elimination. Modified IJF rules will be followed; rules will be discussed on site. No chokes under 13. No arm locks for juniors or in senior novice divisions. Joe Pelletier pellej4@rpi.edu Food will be sold on site. Mr. Billy Martin Tournament Director: Sensei Noriyasu Kudo Driving Directions: See RPI website at www.rpi.edu or online mapping services. Junior Sex Male Female Age 6-8 9-11 12-14 15-16 Rank Beg (White-orange) Adv (Green and above) Weight Light Medium Heavy Super Senior Sex Male Female Rank Sankyu and Below Nikkyu and above Weight kg 60 66 73 81 90 100 100+ (male) Weight kg (female) 48 52 57 63 70 78 78+ Tournament director reserves the right to make changes as needed to insure both safety and fairness for all competitors. Coaches will be informed if it is necessary to add or merge divisions.
For more information or if you have any problems please visit our website at http://judo.union.rpi.edu or e-mail Joe at pellej4@rpi.edu RPI Judo Tournament Entry Form April 30th, 2011 First Name: Last Name: Street Address: City: State: Zip: Phone: E-mail: Age (at time of competition): Rank: Male/Female Membership Card USJI / USJA / USA Judo/ USJF (circle one) Card #: Club: Coach: City: State: Zip: Phone: E-mail: Division Weight (lbs): Girls 6-8 9-11 12-14 15-16 Boys 6-8 9-11 12-14 15-16 Senior Men: Senior Women: Sankyu and below Nikkyu and above Sankyu and below Nikkyu and above Please include with registration: Entry Form & Signed Waiver Certificate for Non-black belt contestants, Certificate of Age, Proof of Age, Power of Attorney Copy of USJI/USJF/USA Judo/USJA membership card Checks payable to RPI Judo Club Copy of a form identification (i.e. driver s license, birth certificate, etc) Attention Referees: Please contact the tournament director if you are available to attend our event. Mail Registration to: RPI Judo Club c/o RPI Union 110 8 th St. Troy, NY 12180
WARNING! WAVIER AND RELEASE OF LIABILITY AND AGREEMENT TO PARTICIPATE In consideration of being permitted to participate in any way, including travel to and from, the RPI Judo Tournament, and related events and activities of United States Judo Association, United States Judo Federation, United States Judo Inc, New York State Judo Inc., RPI Judo Club, Joe Pelletier, and Rensselaer Polytechnic Institute, I hereby: 1. Acknowledge that I am familiar with the sport of Judo and understand the rules governing the sport of Judo. 2. Agree that, prior to participating, I will inspect the mats, equipment, facilities, competition pools or divisions and the elimination scoring system to be used, and, if I believe anything is unsafe, I will immediately advise my coach supervisor, and/or tournament official of such conditions and refuse to participate. 3. Acknowledge and fully understand that I will be engaging in a contact sport that might result in serious injury, including permanent disability or death, and severe social 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, permanent disability, or death. 5. Release, waive, discharge, and covenant not to sue United States Judo Inc., New York State Judo Inc., United States Judo Federation, United States Judo Association, their affiliated clubs, their respected administrators, directors, agents, coaches, and other employees or volunteers of the organization, event officials, Medical Personnel, RPI Judo Club and its affiliates, Noriyasu Kudo, Rensselaer Polytechnic Institute and its affiliates, other participants, coaches, guardian(s), sponsoring agencies, sponsors, advertisers, and if applicable, owners, lessors, and lessees of premises used to conduct the event, all of whom are hereinafter referred to as releasee, from any and all claims, demands, losses, or damages on account of injury, including permanent disability and death and damage to property, caused or alleged to be caused in whole or in part by the negligence of the releasee, or otherwise to the fullest extent permitted by law. 6. Parent(s) or legal guardian(s) of minor participants (under age 18) additionally agree that they will instruct the minor participants to the above warnings and conditions and their ramifications and that they consent to the minor s participation. I HAVE READ THE ABOVE WARNING, WAIVER AND RELEASE, UNDERSTAND THAT I GIVE UP SUBSTANTIAL RIGHTS BY SIGNING, AND KNOWING THIS, SIGN IT VOLUNTARILY. I AGREE TO PARTICIPATE KNOWING THE RISK 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/GUARDIAN AS EVIDENCED BY THE SIGNATURE BELOW. Participants Printed Name Participants Signature Date FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE (UNDER 18 AT TIME OF REGISTRATION) This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release, as provided above, of all Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless Releasees from any and all liabilities incident to my minor child s involvement or 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/Guardian s Printed Name Parent/Guardian s Signature Date
CERTIFICATE REGARDING NON-BLACK BELT CONTESTANTS (Sankyu and below wishing to compete in nikkyu and above divisions) I,, a Judo Instructor, who has been (Name of Instructor) awarded the Judo rank of Shodan or higher, recognized by United States Judo, Inc., hereby certify that,, although not having been awarded the Judo rank of Shodan or higher, is of sufficient aptitude and skill in Judo to compete in this tournament. A copy of my proof of rank (rank certificate or my membership card having the verification symbol (V) printed following my rank) is attached. Date Signature of Judo Instructor CERTIFICATE OF AGE I certify that I am at least 18 years of age as of April 30th, 2011. A copy of my birth certificate, military identification, passport, voter registration card passport, or my membership card having the verification symbol (V) printed following my date of birth is attached... Signature of parent or guardian if contestant.signature of Contestant is under 18 years of age. POWER OF ATTORNEY If contestant if under the age of 18 years on the day of competition, this document must completed by the contestant s parent or legal guardian if the parent or legal guardian is not attending the Tournament. I certify that I am the parent or legal guardian of, a minor. I will not be in attendance at the Championships and do hereby designate, who is over 21 years of age, to be my true and lawful attorney, to act in my name, place, and stead, to do any and every act and exercise any power that I might or could do or exercise through any other person and that he/she shall deem proper or advisable, intending hereby to vest in the person acting for me full power and authority to do and perform all and every act and thing. Date Signature of parent or legal guardian
Advertisement Order Form Cheer on your judoka! Buy a place in our program! Package (circle): SPONSOR FULL PAGE HALF PAGE QUARTER PAGE EIGHTH PAGE Name/Company: Contact Person: Address: City: State: Zip: Phone: Email: Package Price Full Page 100.00 ½ Page 50.00 ¼ Page 24.00 1/8 Page 12.50 1 Line 5.00 Each additional line 3.00 To order, please mail this sheet, a copy of your design/logo, and cash/check to: RPI Judo Club, 110 8 th St, Troy, NY 12180. Designs/Logos can be emailed to Joe Pelletier at pellej4@rpi.edu If you have any questions, feel free to contact us at (781) 789-3750. Please make checks payable to : RPI Judo Club Deadline: Friday, April 30th, 2011