Saturday March 15th 2014 11:30 am to 4:00 pm Smith Middle School Auditorium 216 Addison Rd Glastonbury, CT (Doors open at 11:15 am)
General Admission Adults ‐ $13.00 Children (7‐15y.o) ‐ $7.00 Children under 6 y.o. ‐ free
Participants $15.00 All Registration Forms MUST be returned to your sensei no later than March 8th to participate in the tournament. Participants are required to wear a gi (uniform) to the event. No entry without a gi.
Name:________________________ Age: _______ Height: ________ Rank:_________ Sensei: _____________ Dojo Town: ____________ I understand that due to the nature of martial arts training, there is a RISK OF INJURY and that in the event of such injury, I shall NOT hold responsible the International Kokondo Association (IKA), IKA LLC, Smith Middle School in Glastonbury, CT or the Glastonbury BOE, the aforementioned officers, students, instructors, directors, or anyone connected to this Randori Tournament. Further, I understand and agree that I am obligated to certify and attest that I am in good health, AND hold myself responsible for not supplying a physician’s confirmation of GOOD HEALTH. I further agree that IKA LLC may use any photos or images taken of me for commercial PURPOSES without compensation to me. I understand and agree to all the above.
I am entitled to a copy of this waiver. Print Name of Participant: __________________________________________________ Signature: _______________________________________________ DATE: ____________________ (If Registrant is a minor, Parent/Guardian Signature) Make check payable to: IKA, LLC