Hollis Park Judo Invitational Judo Tournament You are cordially invited to attend a Judo Tournament hosted at the Hollis Park Recreation Center. Tournament Venue: Hollis Park Recreational Center 10107 Vine Street Mapleton, IL 61547 (see attached map) 309-697-2929 Event Date: Saturday January 7, 2017 Awards: Medals for 1 st, 2 nd and 3 rd place Entry Fee: $20, $5 for each additional division Weigh-in: 10:30am 12pm Competition: 1:30pm Two Competition Areas All matches will be three minutes in duration All players are guaranteed, no fewer than, two matches Golden Score will be used where neither players earns a score during regulation time. Kata Competition: The Hollis Park Judo Tournament will include Kata Competition. Kata competition will take place before the Shiaii matches. Referees: For each volunteer Referee, one contestant, from that volunteers Team, may be registered, in the competition, free of charge. This tournament is not a pr eregistration event. However, for the sake of convenienc e, the registration form and Liability Waiver have been included in this package. Preparing the forms in advanc e will make r egistration much more efficient. R egistration fors will be available at the registration table. Tournament Director: George Weers 1121 Royal Ave. Pekin, IL 61554 309-635-4154 g.weers@comcast.net
Hollis Park Shiaii Registration A separate registration form must be prepared for each division being entered. Entry Fees, for each additional division, will be assessed at $5. Name: Male Female Date of Birth: Age: Judo Rank: Registration Card #: USJA USJF USJI (circle one) Address: City: State: Zip Code: Telephone: email: Club Name: Tournament Division Entered (circle one): Juniors Boys Junior Girls Adult Men Adult Women Masters Official Use Only Entry Fee Registration Verified Official Weight JUNIORS ONLY Control Number (Age*4 + Wt) Division Page 2 of 6
Hollis Park Shiaii Registration WARNING, WAIVER, RELEASE OF LIABILITY, ASSUMPTION OF RISK AND AGREEMENT TO PARTICIPATE THIS AGREEMENT MUST BE SIGNED BY ALL MEMBERS WHO WISH TO PARTICIPATE IN ANY SANCTIONED ACTIVITY OR EVENT of the Hollis Park Recreational Center Judo Team. In consideration of being allowed to participate in any way in the sanctioned events of the Hollis Park Recreational Center Judo Team, I, : 1. Recognize and understand that martial arts training is a physical contact activity and that my participation might result in serious injury, including permanent disability or death, and severe social and economic loss. 2. Recognize and understand that such risk may be due to, not only, my own actions, but also the action, inaction or negligence of others, the regulations of participation, or the conditions of the premises, or of any of the equipment used. 3. Recognize that there may be other risks that are not known to me or to others or not reasonably foreseeable at this time. 4. Agree to inspect the facilities, equipment and pairings prior to participation. I will immediately inform an instructor of the Academy if I believe that anything is unsafe or beyond my capability and refuse to participate. 5. Assume all the foregoing risks and accept personal responsibility for any damages that may result from injury, permanent disability or death. 6. Enter martial arts training and/or competition entirely of my own free will and understand the importance of following the rules of training and competition. I have been given a copy of the rules and regulations of the Starkville Martial Arts Academy and agree to abide by the instructions given therein. 7. I certify that I am in good physical condition, and have no disease, injury or other condition that would impair my performance or physical and mental well-being during intense training practice and/or competition. 8. Grant permission in case of injury to have a doctor, nurse, athletic training or other emergency medical personnel provide me with medical assistance or treatment for such injury. 9. Release, waive, discharge and covenant not to sue, Hollis Park Recreational Center Judo Team or the Hollis Park District, United States Judo Association, affiliated organizations and national governing bodies, their officers, instructors and personnel, other members of the organizations, participants, supervisors, coaches, sponsoring organizations or their agents, and if applicable, owners and leasers of the premises from any and all liability to the undersigned, his or her heirs and next of kin for any and all claims, demands, losses and damages which may be sustained and suffered on account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the releasees or otherwise. I HAVE READ THE ABOVE WARNING, WAIVER, RELEASE AND AGREEMENT TO PARTICIPATE. I UNDERSTAND ITS CONTENTS AND DO HEREBY SIGN IT VOLUNTARILY. Printed Name Signature Date Page 3 of 6
Hollis Park Kata Team Registration Entry Fee for Kata Teams shall be assessed as the Tournament Entry Fee for a single entry (ie. Each Kata Team Member pays half the event fee.) A separate registration form must be prepared for each Kata being entered. Entry Fees, for each additional Kata, will be assessed at $5 per team. Name 1: DoB: Age: Address: City: State: Zip Code: Telephone: email: Club Name: Name 2: DoB: Age: Address: City: State: Zip Code: Telephone: email: Club Name: Kata Entered Circle the Kata AND Full Kata OR the Sets to be performed. Nage No Kata Full Kata Set 1 Set 2 Set 3 Katame No Kata Full Kata Set 1 Set 2 Set 3 Ju No Kata Full Kata Set 1 Set 2 Set 3 Goshin Jitsu Full Kata Set 1 Set 2 Set 3 Set 4 Set 5 Kime No Kata Full Kata Set 1 (Idori) Set 2 (Tachiai) Official Use Only Entry Fee Registration Verified Page 4 of 6
Hollis Park Kata Team Registration WARNING, WAIVER, RELEASE OF LIABILITY, ASSUMPTION OF RISK AND AGREEMENT TO PARTICIPATE THIS AGREEMENT MUST BE SIGNED BY ALL MEMBERS WHO WISH TO PARTICIPATE IN ANY SANCTIONED ACTIVITY OR EVENT of the Hollis Park Recreational Center Judo Team. In consideration of being allowed to participate in any way in the sanctioned events of the Hollis Park Recreational Center Judo Team, I, : 1. Recognize and understand that martial arts training is a physical contact activity and that my participation might result in serious injury, including permanent disability or death, and severe social and economic loss. 2. Recognize and understand that such risk may be due to, not only, my own actions, but also the action, inaction or negligence of others, the regulations of participation, or the conditions of the premises, or of any of the equipment used. 3. Recognize that there may be other risks that are not known to me or to others or not reasonably foreseeable at this time. 4. Agree to inspect the facilities, equipment and pairings prior to participation. I will immediately inform an instructor of the Academy if I believe that anything is unsafe or beyond my capability and refuse to participate. 5. Assume all the foregoing risks and accept personal responsibility for any damages that may result from injury, permanent disability or death. 6. Enter martial arts training and/or competition entirely of my own free will and understand the importance of following the rules of training and competition. I have been given a copy of the rules and regulations of the Starkville Martial Arts Academy and agree to abide by the instructions given therein. 7. I certify that I am in good physical condition, and have no disease, injury or other condition that would impair my performance or physical and mental well-being during intense training practice and/or competition. 8. Grant permission in case of injury to have a doctor, nurse, athletic training or other emergency medical personnel provide me with medical assistance or treatment for such injury. 9. Release, waive, discharge and covenant not to sue, Hollis Park Recreational Center Judo Team or the Hollis Park District, United States Judo Association, affiliated organizations and national governing bodies, their officers, instructors and personnel, other members of the organizations, participants, supervisors, coaches, sponsoring organizations or their agents, and if applicable, owners and leasers of the premises from any and all liability to the undersigned, his or her heirs and next of kin for any and all claims, demands, losses and damages which may be sustained and suffered on account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the releasees or otherwise. I HAVE READ THE ABOVE WARNING, WAIVER, RELEASE AND AGREEMENT TO PARTICIPATE. I UNDERSTAND ITS CONTENTS AND DO HEREBY SIGN IT VOLUNTARILY. Printed Name Signature Date Page 5 of 6