Sample Championship Registration Form (Page 2 of 2) in pdf

2015-16 Gulf Coast Martial Art Championships Entry Form

Competitor’s Last Name________________________ First Name___________________________

Address_______________________ City ___________________ State______________ Zip _________

Phone_(_____)______________ Email_________________________________ DOB (MM/DD/YEAR) _____/_____/____

Instructor______________________ Instructor’s Phone_(____)_________________ Email____________________

Instructor Address______________________ City _____________________ State__________ Zip _________

Check all that apply to you:

BEGINNER forms & sparring:

INTERMEDIATE forms & sparring:

ADVANCED forms & sparring:

BLACK forms & sparring: Black

white, yellow, & orange

green, blue, & purple

red & brown

belts must compete here

(Typically less than year

(Typically 1-2 years of

(Typically 2+ years of

regardless of time in rank

of training)

training)

___BLACK 10 & Under Forms

___BLACK 10 & Under Sparring

___JR. BEG. 4-6 Forms

___JR. INT. 4-6 Forms

___JR. ADV. 4-6 Forms

___JR. BEG. 4-6 Sparring

___BLACK 11-13 Forms

___JR. INT. 4-6 Sparring

___JR. ADV. 4-6 Sparring

___BLACK 11-13 Sparring

___JR. BEG. 7-8 Forms

___JR. INT. 7-8 Forms

___JR. ADV. 7-8 Forms

___JR. BEG. 7-8 Sparring

___BLACK 14-17 Forms

___JR. INT. 7-8 Sparring

___JR. ADV. 7-8 Sparring

___JR. BEG. 9-10 Forms

___JR. INT. 9-10 Forms

___JR. ADV. 9-10 Forms

___BLACK 14-17 Sparring

___BLACK 18-33 Forms

___JR. BEG. 9-10 Sparring

___JR. INT. 9-10 Sparring

___JR. ADV. 9-10 Sparring

___JR. BEG. 11-13 Forms

___JR. ADV. 11-13 Forms

___BLACK ADULT MALE 18-33

___JR. INT. 11-13 Forms

___JR. BEG. 11-13 Sparring

Sparring

___JR. INT. 11-13 Sparring

___JR. ADV. 11-13 Sparring

___BLACK ADULT FEMALE 18-33

___JR. BEG. 14-17 Forms

___JR. INT. 14-17 Forms

___JR. ADV. 14-17 Forms

Sparring

___JR. BEG. 14-17 Sparring

___JR. INT. 14-17 Sparring

___JR. ADV. 14-17 Sparring

___ADULT BEG. 18-33 Forms

___ADULT ADV. 18-33 Forms

___SR. BLACK 34+ Forms

___ADULT INT. 18-33 Forms

___ADULT MALE BEG. 18-33

___SR. BLACK MALE 34+

___ADULT MALE INT. 18-33

___ADULT MALE ADV. 18-33

Sparring

___ADULT FEMALE BEG. 18-33

___SR. BLACK FEMALE 34+

___ADULT FEMALE INT. 18-33

___ADULT FEMALE ADV. 18-33

Sparring

___MASTERS 15+ Years in

___SR. ADULT BEG. 34+ Forms

___SR. ADULT INT. 34+ Forms

___SR. ADULT ADV. 34+ Forms

___SR. ADULT MALE BEG. 34+

___SR. ADULT MALE INT. 34+

___SR. ADULT MALE ADV. 34+

training FORMS

Sparring

___MASTERS 15+ Years in

Sparring

___SR. ADULT FEMALE BEG.

training SPARRING

___SR. ADULT FEMALE INT. 34+

___SR. ADULT FEMALE ADV. 34+

34+ Sparring

Sparring

Specialty Divisions –

Musical Division

Self Defense Division

Weapons Division

Have you changed

___BEG. & INT. Musical Forms

___ Self Defense (color belt junior)

___Weapons color belts junior

divisions since last

(Empty hand or weapons)

___ Self Defense (black belt junior)

___Weapons color belts adult

tournament?

___ADV. & BLK. Musical Forms

___ Self Defense (color belt adult)

___Weapons black belts junior

Yes □

No □

(Empty hand or weapons)

___ Self Defense (black belt adult)

___Weapons black belts adult

Schedule of Events:

Entry Fee

8AM-10AM

Registration

$60 for 1-3 events

9:00AM

Start weapons & musical forms

$10 for each additional event

9:30AM

Black Belt meeting

10AM

National anthem, prayer, & bow in.

Spectator Tickets

Start with Black Belt Adult Forms so they can judge. Then Colored belts &

Adults $5 - Children $3

Junior Black belts followed by self-defense division. Adult Black Belt

(5 & under are free)

sparring is last.

No Refunds - No Personal Checks

MUST pre-register if you're going to do weapons or musical. The

registration line tends to get long at times. As always, we want to have

the best event possible and try to keep things running smoothly.

Liability Waiver. Read & sign: All minors under 18 must have parent's signature. The participant hereby agrees to comply with the

Gulf Coast Martial Art Championships rules and acknowledges that competition in the tournament is physical and participation can

cause serious injury and even death to the participant. The participant hereby waives any claim of accidental and negligent tort

damages or injuries against the Gulf Coast Martial Art Championships, Thomas Gordon, participants, any officials, and employees

connected with the organization or promotion of the Gulf Coast Martial Art Championships and expressly assumes an assumption of

risk whatever nature resulting in participation. Additionally, participant acknowledges that he/she is fully aware of his/her medical

condition and hereby certifies that he/she is mentally, emotionally, and physically fit to compete. Lastly, the participant waives any

compensation for use of pictures, video tapes, media coverage, statements, interviews, etc. utilized by those producing and/or

directing the Gulf Coast Martial Art Championships.

Signature (participant under 18 must have a parent or legal guardian signature)

Date

Sample Championship Registration Form Page 2

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