2024 Gold Mountain Invitational Youth Karate Tournament Application Form

First Name *

Last Name *

Age *

Rank *

Address *

City *

State *

Zip Code *

Country *

Phone Number *

Email Address *

Would you like to sign up for our newsletter?

Yes! I would like to receive occasional updates from Grass Valley Kenpo Family Karate.

Studio Name *

Instructor *

Type of Martial Art *

Years in the Art *

Sex *

Male

Female

Individual Events *

Traditional Kata

Weapons

Point Sparring

Synchronized Kata

Synchronized kata can be 2 or 3 competitors

I Agree to the terms and Agreements *

RELEASE AND WAIVER OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT In consideration of being permitted to participate in this event, the undersigned, for himself/herself, he/her personal representatives, assigns, heirs, and next of kin: Hereby releases, waives, discharges, and covenants not to sue the Gold Mountain Invitational Youth Karate Tournament, its promoters, sponsors, participants, officials, rescue personnel, advertisers, landowners, lessees, and permitees of the premises used to conduct the even, and each of them, and their respective directors, officers, agents, and employees, and all others whether listed herein by name or category or neither, all for the purpose herein referred to as “Releasees”, from all liability to the undersigned, his personal representative, assigns, heirs, and next of kin, for any and all loss or damage, and nay claim or demands, therefore, on account of injury to the person or property or resulting death of the undersigned, arising of or related to the undersigned’s participation in the event, whether causes by the negligence of the Releasees or otherwise. Hereby acknowledges that there is the risk of serious injury and/or death and/or property damage from participating in the event. Each of the undersigned also expressly acknowledges that injuries received may be compounded or increased by negligent rescue operations or procedures of the Releasees, all of which are released and waived. In connection with my participation in The Gold Mountain Invitational Youth Karate Tournament, I consent to the use of my photograph and video or other likeness in the promotional and other materials of The Gold Mountain Invitational Youth Karate Tournament without payment or other consideration made to me. In addition, I agree to pay the tournament fee of $40.00 ($35 for earlybirds).

2024 Gold Mountain Invitation Youth Karate Tournament Registration Form