Seven-Star Cup Registration & Waiver Form Please read carefully and sign
Advanced Competitors Only (4 years of
experience and up)
Last Name:
____________________________________ First Name:
___________________________________
Age: ________ Date of Birth
(MM/DD/YYYY):________________________ Male / Female (circle one)
Telephone: ___________________________________
Email:________________________________________
Street Address:_______________________________________________________________________________
___________________________________________________________________________________________
City:
Country:
______________________________________________________ Weight:
______________________
Division: (Circle one) Men 18 & Over / Women 18 & Over / Male Teen 13 – 17 / Female Teen 13 - 17
Emergency Contact: _________________________Emergency
Contact Phone: ___________________________
School Name: _______________________________________________________________________________
SiFu or Instructor:
____________________________________________________________________________
School Address:
___________________________________________________________________________________________
___________________________________________________________________________________________
Registration
Fee: $65.00 all events Cash/Money Orders Event Day Only
Pre-registration
Fee: $45.00 all events Checks/Money Order for Pre-registrations Only
Pre-registration
Deadline: MUST be post-marked by
I, the
undersigned, knowingly, and without duress, do voluntarily submit my entry into
the Luo Kwang Yu Heritage All Kung Fu
Championship
sponsored by the Gaam Sing Association Inc. I assume full responsibility for
any and all damages, injuries, or losses that I may sustain from this event. I
understand that any medical treatment given to me will be of a first aid type
only. I do hereby release the National Capital YMCA, Othal Thomas, Gaam Sing
Association Inc, and the Gaam Sing Association members, volunteers, assistants,
and agents, of and from any and all liability, actions, claims, demands, or
suits whatsoever, which I may now or hereafter have or claim to have, on
account of any injury and/or loss sustained and suffered by me in connection
with this event. I also understand that there is a risk of injury or even death
involved in all competitive divisions, particularly in all of the contact
events, and I assume full responsibility for all my actions in connection with
this event. I consent to the use of photography/video of my participation in
this event for promotions purposes, and hereby waive my rights to any
compensation or claim.
Signature of
Competitor Signature of Parent/Guardian if under 18
_________________________________________________________________________Date:______________________