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(18++)  ADULT WARRIORS DOUBLE ELIMINATION 50/50 pot

 

 

NAME   ___________________________________________________________________________________

 

 

ADDRESS   ________________________________________________________________________________

 

  

PHONE   ___________________________________________________________________________________

 

 

E-MAIL   ___________________________________________________________________________________

 

 

AGE   _________________________   (as of tournament date)

 

 

 

MARTIAL ARTS STYLE   ____________________________________________________________________

 

 

GENDER (circle one)   …..   MALE   ……….  FEMALE

 

 

MARTIAL ARTS SCHOOL NAME   ______________________________________________________________

 

 

MARTIAL ARTS INSTRUCTOR   ________________________________________________________________

 

 

MARTIAL ARTS SCHOOL PHONE   _____________________________________________________________

 

 

MARTIAL ARTS SCHOOL E-MAIL   _____________________________________________________________

 

 

MARTIAL ARTS SCHOOL WEB-PAGE   __________________________________________________________

  

 Athletic Waiver and Release of Liability

In consideration of being allowed to participate in any way in  ADULT WARRIORS athletics / sports program, and related events and activities, the undersigned :

I. I Agree that I shall prior to participating , he or she should inspect the facilities and equipment to be used, and if the participant believes anything is unsafe, he or she will immediately advise of such condition(s) and refuse to participate.

2. I  Acknowledge and fully understand that each participant will be engaging in activities that involve risk of serious injury, and losses which might result not only from their own actions, inactions or negligence but the actions, inactions or negligence of others, the rules of play, or the condition of the premises or of any equipment used. Further, that there may be other risks not known to us or not reasonably foreseeable at this time.

3. I  Assume all the foregoing risks and accept personal responsibility for the damages following such injury.

4. I  Release, waive, discharge and covenant not to sue  ADULT WARRIORS, its officers, its affiliated clubs, regional sports organizations, their respective administrators, directors, agents, coaches, and others of the organization or volunteers, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessees of premises used to conduct the event, all of which are hereinafter referred to as "releasees" from any and all liability to the undersigned, his or her heirs and next of kin for any and all claims, demands, losses or damages on account of injury or damage to property, caused or alleged to be caused in whole or in part by the negligence of the releasee or otherwise.

The undersigned have read the above waiver and release, understand that they have given up rights by signing it and sign it voluntarily.

 

 (Adult)Participant Signature_____________________________________________________________________________________________________________Date_________/_________/__________

 

 

 

 

Protest must be in writing and submitted with $25.00 cash for each protest.

Make funds payable to: Kenneth Lowe Send to: 1400 W.Washington Broken Arrow, Ok 74012