Rock and Roll Championships 2019

Full Name of Competitor *

First Name Last Name

Address *

Street Address

City *

State *

Birth Date *

Month Day Year

Age as of date of Tournamnent *

Rank in Judo *

Sex *

Male Female

Judo Registration Organization *

Registration Card Number *

Note: Card must be presented at Weigh-in on day of tournament

Registration Card Expiration Date *

Note: If your Judo Registration expires before 09/21/19, Please renew your registration before completing your online registration for this tournament.

Weight of Competitor in Pounds

Cost of Entering

2nd Division Cost

First Division Submission (Note: Kata and Shiai Competitions must register separately) *

Junior Senior Masters Kata (Note: Only one person should apply for pre-registration for him and his partner)

Number of Kata's being performed (50$ for first registration, 25$ for each additional. *

Note: You will need to complete additional registration steps the day of the tournament with all partners that are performing Kata.

Are you planning on competing in more than one division? *

Second Division Submission *

Junior Senior Masters

For Second Division Pooling, please select preferred option *

Up in Weight Up in Age Doesn't Matter to Me.

Judo Club *

Name of Instructor *

Rank of Instructor *

E-mail Address of Instuctor *

Confirmation Email

Division 1 Cost

Division 2 Cost

Waiver

WAIVER AND RELEASE OF LIABILITY AND AGREEMENT TO PARTICIPATE&#13;&#10;&#13;&#10;In consideration of being permitted to participate in any way, including travel to and from, the 2019 Rock & Roll Capital of the world Judo Tournament and related events and activities of United States Judo, Inc., United States Judo Association, United States Judo Federation, ATJA, AJJF, Ohio Judo, Inc., City of Lorain, The Church of the North Coast and Chu To Bu Judo Club, Inc. and Chu To Bu Brasa I hereby:&#13;&#10;&#13;&#10; 1. Acknowledge that I am familiar with the sport of Judo and understand the rules governing the sport of Judo.&#13;&#10; 2. Agree 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 condition(s) and refuse to participate.&#13;&#10; 3. Acknowledge and fully understand that I will be engaging in a contact sport that might result in serious injury, including permanent disability or death, Traumatic Brain Injury (TBI), and severe social and economic losses due not only my own actions, inactions or negligence, but also to the action, inaction 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.&#13;&#10; 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, permanent disability or death.&#13;&#10; 5. Release, waive and discharge and covenant not to sue the United States Judo, Inc., United States Judo Association, United States Judo Federation, ATJA, AJJF, Ohio Judo, Inc., City of Lorain, The Church of the North Coast and Chu To Bu Judo Club, Inc. and Chu To Bu Brasa together with their affiliated clubs, their respective administrators, directors, agents, coaches, and other employees or volunteers of the organization, event officials, medical personnel, other participants, their parents, guardian(s), supervisors and coaches, sponsoring agencies, sponsors, advertisers, and, if applicable, owners, lessors, and lessees of premises used to conduct the event, all of whom are hereafter referred to as "releasee", from any and all claims, demands, losses, or damages on account of injury, including permanent disability or death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the releasee or otherwise to the fullest extent permitted by law.&#13;&#10;&#13;&#10;I HAVE READ THE ABOVE WARNING, WAIVER AND RELEASE, UNDERSTAND THAT I GIVE UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND KNOWING THIS, SIGN IT VOLUNTARILY. I AGREE TO PARTICIPATE KNOWING THE RISKS AND CONDITIONS INVOLVED AND DO SO ENTIRELY ON 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/GUARDIAN AS EVIDENCED BY THEIR SIGNATURE BELOW.&#13;&#10;&#13;&#10;FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE&#13;&#10;(UNDER AGE 18 AT TIME OF REGISTRATION)&#13;&#10;&#13;&#10;This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release, as provided above, of all the Releases, and for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releases from any and all liabilities incident to my minor child's involvement or 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.&#13;&#10;&#13;&#10;

Read Waiver Above *

I have read the above waiver document in full.

By typing your name in this box you are agreeing to the waiver document above in full. Note: This must be filled out by Parent or Legal Guardian for any minor. *

Email Address of Person Signing Waiver *

Total Cost

Kata 2

Kata 3

Kata 4

Kata 5

Final Price hidden

Final Price

USD Description