Hosted by: International Women s Judo Alliance Sanctioned by U.S.J.F: #15-10-06 SATURDAY, OCT. 10TH, 2015 SHIAI AND KATA COMPETITION At the venue Registration & Weigh in: Oct 9-5::00pm - 6:30 pm Oct 10-7:00 8:30 am Referees Meeting 9:00 am Opening Ceremonies 10:30 am VENUE West Catholic High School 1801 Bristol Ave NW Grand Rapids, MI 49504 Clinics. The Great Lakes Open will take place at the same Venue Oct. 11, 2015 Please join us for the 10 th Annual All Women s Judo Championships Oct. 10, 2015 in Grand Rapids, MI. We aim to provide you first class service and facilities for this premier Women s Judo Event. Open to all Female Judoka, National and International. ~Special Guests~ Head Kata Judge and Clinician Frances Glaze Chief Referee and Clinician TBD Technical Clinician: Deborah Fergus Pre-Registration is necessary to ensure a great tournament. REGISTRATION INFORMATION Pre-Registration Shiai (plus Open) $ 50.00 On Site Registration Shiai $ 65.00 additional divisions no charge Pre-registration Kata (pair) any number of Kata $ 60.00 On Site Registration Kata (pair) (two Kata) $ 75.00 Novice Kata (pair) (includes up to two Kata**) $ 40.00 On site Novice Kata $55.00 Clinic registration (shiai / kata contestants) $ 20.00 Clinic registration (non contestants) $ 40.00 All funds USD Pre-registration by mail ends 09/26 /15 Mail to DEBORAH L. FERGUS 2006 Wickwire Rd. Benton Harbor, MI 49022 Make checks payable to Deborah Fergus (postmarked by 09/26/15) defrgs6@att.net DIVISIONS JUNIOR (AGES) SENIOR MASTERS (AGES) White - Green Brown - Black Light / Middle / Heavy categories in each Open Division for 17 years and Up Pooling may be adjusted on site to accommodate numbers at the discretion of the tournament director. 6-8 yr 9-10 11-12 13-14 15-16 Light / Middle / Heavy categories in each 30-39 yr 40-49 50-59 60+ Light / Middle / Heavy categories in each Open Division for 30 years and up KATA Nage no Kata Katame no Kata Ju no Kata Goshin-Jutsu Kime no Kata Tournament Director Deb Fergus defrgs6@att.net Tournament Co-Director & Registrar Julee Cope juleecope@hotmail.com Tournament Liaison Louise Ullman troyjudoullman@aol.com
Official use only Weight: Make checks payable to Deborah Fergus Registration Checklist: Send entry forms to: DEBORAH L. FERGUS 2006 Wickwire Rd. Benton Harbor, MI 49022 Completed Registration form Certificate regarding Non-Black belt Waiver and Release agreement Registration number or application Division: Registration Type: ONSITE PRE-REG ( rcvd: ) Verified By / Date: Check: Check # $ Name on check: Cash: $ Official Entry Form Name: Address: City, State, Zip: Country: Phone Number: Email Address: If assistance/accommodation is needed (check off appropriate box) Vision Loss/Blindness Hearing loss/deafness Other Type of assistance/accommodation requested or name of person assisting Age: Date of Birth: Club: Select one or more Reg # Expires USJF: USA Judo: USJA: Foreign NGB: Judo Rank (not color of belt): Select one division per registration form Junior Divisions: 6-8 yr 9-10 11-12 13-14 15-16 Senior Divisions: White - Green Brown - Black Master Divisions: 30-39 yr 40-49 50-59 60+ Weight: Kata Division: (Tori) (Uke) OPEN DIVISION: (Jr) (Sr) (Master) Please submit a separate registration form for each division that you would like to enter. CERTIFICATE REGARDING NON-BLACK BELT CONTESTANT I verify that I am a Judo instructor who holds the Judo Rank of Shodan or higher, which has been awarded under the auspices of the United States Judo Federation, Inc., United States Judo Association, or United States Judo, Inc., hereby certifies 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 the above described event. Name of Judo instructor Signature of Judo Instructor
Eligibility: This tournament is open to all Female Junior, Senior, and Master Competitors as well as female Kata pairs. All contestants must provide a valid U.S.J.F., U.S.J.I. (USA Judo), or U.S.J.A. card. Foreign contestants must have the proper ID and NGB# from their home country. U.S.J.I., U.S.J.F., and U.S.J.A. applications will be available at the tournament site. All junior s competitors must have a signed consent head up concussion form Entry Fees: Mail-in registration ends 09/26/2015 (postmarked by 09/26/2015) ~Shiai is $50.00 no charge for extra divisions. ~Kata is $60.00 any number of Kata. ~Novice Kata is $40.00 for up to two (choose from): First three sets of Nage No Kata, First set Juno Kata, First set Katame No Kata Entries with incomplete or missing information will be considered walk up registration unless the required material is received before 09/26/2015. On-Site Registration (day of event) ~Shiai is $65.00 ~Kata is $75.00 for two Kata. ~Novice Kata is $55.00 (choose one): First three sets of Nage no Kata, First set Ju no Kata, and First set Katame no Kata Scoring: ~Modified Double Elimination (4 or more in a division) ~Round Robin (3 or less in a division) Match Times: ~Senior and Master s Division, 3 min. ~Junior: 3 min Rules and Methods of Elimination: - Current IJF rules as modified below for local competition will be in effect. - 3 mats sized 8m x 8m with a 3 meter safety area on perimeter 4 meters between the two mats will be used. - The care system will be used on two of the mats. The 3rd mat will have three officials on the mat. - Pre-2003 rules regarding medical attention will be used. - Shime waza (chokes) allowed for 13 yrs. of age and older. - NO kansetsu waza (Arm Locks) allowed in Junior or Novice Divisions. Judogi & Obi: The use of blue Judogi is optional. All competitors MUST have a white Judogi. Competitors called to the white side MUST wear white, and will not be allowed to compete in a blue Judogi. Competitors must bring a white and blue belt. Judogi must be worn to receive awards. White tee shirts are required for competition. Award Presentations: Medals/Trophies for 1st, 2nd, and 3rd place winners in all divisions. Ribbons for Team competition. Please let us know if you will be participating in Team. Teams will be made up at the venue Contestants must be in Judogi to receive awards. Awards will be presented at the end of the tournament so we can all cheer each other. All age/weight/rank categories may be modified depending on the weight range of the contestants entered and after considering fairness and safety of the competitors. Any situation not covered by the above will be decided by the tournament director.
REGISTRATION FEE WORKSHEET: Pre-Registration Shiai (plus Open) $50.00 On Site Registration Shiai $65.00 (Separate registration required for each division) Pre-registration Kata (pair) any number of Kata $ 60.00 On Site Registration Kata (pair) (two Kata) $ 75.00 Novice Kata (pair) (includes up to two Kata**) Pre register $50, On site $65 $ 50.00/$65.00 Clinic fee (contestants) $20.00 Clinic fee (non-contestants) $40.00 Team competition let us know. No charge Yes No TOTAL: Host Hotel: Quality Inn Grand Rapids North 2171 Holton Court NW, Walker, MI 49544 Phone: (616) 791-8500 Baymont Inn & Suites 2151 Holton Court NW, Walker, MI 49544 Phone: (616) 735-9595
WARNING! WAIVER AND RELEASE OF LIABILITY AND AGREEMENT TO ARTICIPATE 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., Konan Judo Yudanshakai, Inc., Deborah Fergus, Julee Cope, Louise Ullman, and the Southside Dojo, Ltd, 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., Konan Judo Yudanshakai, Inc., Deborah Fergus, Julee Cope, Louise Ullman, and the Southside Dojo, Ltd, 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
2015 All Women s Championship HEAD UP WAIVER For those under 18; this form must be signed by the parent or guardian and minor CONCUSSION DANGER SIGNS In rare cases, a dangerous blood clot may form on the brain in a person with a concussion and crowd the brain against the skull. An athlete should receive immediate medical attention if after a bump, blow, or jolt to the head or body s/he exhibits any of the following danger signs: One pupil larger than the other Is drowsy or cannot be awakened A headache that gets worse Weakness, numbness, or decreased coordination Repeated vomiting or nausea Slurred speech Convulsions or seizures Cannot recognize people or places Becomes increasingly confused, restless, or agitated Has unusual behavior Loses consciousness (even a brief loss of consciousness should be taken seriously) WHAT SHOULD YOU DO IF YOU THINK YOUR ATHLETE HAS A CONCUSSION? 1. If you suspect that an athlete has a concussion, remove the athlete from play and seek medical attention. Do not try to judge the severity of the injury yourself. Keep the athlete out of play the day of the injury and until a health care professional, experienced in evaluation for concussion, says s/he is symptom-free and it s OK to return to play. 2. Rest is key to helping an athlete recover from a concussion. Exercising or activities that involve a lot of concentration, such as studying, working on the computer, and playing video games, may cause concussion symptoms to reappear or get worse. After a concussion, returning to sports and school is a gradual process that should be carefully managed and monitored by a health care professional. 3. Remember: Concussions affect people differently. While most athletes with a concussion recover quickly and fully, some will have symptoms that last for days, or even weeks. A more serious concussion can last for months or longer. WHY SHOULD AN ATHLETE REPORT THEIR SYMPTOMS? If an athlete has a concussion, his/her brain needs time to heal. While an athlete s brain is still healing, s/he is much more likely to have another concussion. Repeat concussions in your athletes can result in brain swelling or permanent damage to their brain. They can even be fatal. By my name and signature below, I acknowledge in accordance with Public Acts 342 or 2012 that I received and reviewed this concussion educational material. STUDENT-ATHLETE NAME PRINTED STUDENT-ATHLETE NAME SIGNED DATE PARENT OR GUARDIAN NAME PRINTED PARENT OR GUARDIAN NAME SIGNED DATE