Albany Invitational by ps94506


									                  44rd Annual Albany Judo Invitational

                                       Official Entry Form
Official Use Only

Sex    Age       Weight              Rank          Time in Judo             Pool Number

Please Print All Information

Contestant’s Name:
                          Last                               First          Middle Initial

Home Address:
                          Number and Street                          City                    Zip

Telephone Number:                                  Name of Parent:

Date of Birth:        /          /          Age:             Weight:                Sex: M / F

Judo Rank/Color Belt;                              6kyu      5kyu    4kyu   3kyu 2kyu        1kyu
                                                                            circle one

Judo Club                                          Sensei:

Registration number: USJF:                         USJA:                    USJI;

Power of Attorney
I/We hereby authorize the following named persons:                                    to act on
my behalf in any and all matters requiring parental consent for my child during the event or
travel to or from it.

Parent ‘s Signature                                                         Date

For Non-Black Belt Competitors Competing in a Black Belt Pool
This certifies that the above named contestant, although not having been awarded the rank of
Shodan, is of sufficient aptitude and skill to compete in matches with Shodans or higher with the
understanding that all matches will be held under Black Belt rules.

Instructor’s Signature and Rank (Shodan or above) Club and Yudanshakai

Emergency Contact:
                                     Name                                   Phone Number
                 44th Annual Albany Judo Invitational
Date:                Sunday, October 18, 2009

Location:            Albany High School, 603 Key Route Blvd., Albany California

Sanction:            USA , Judo, Inc.

Eligibility:         All individuals with current USJI, USJF or USJA .
                     (Must present registration card .)

Registration Time:
                     Junior Division:             8:00 to 9:30 a.m.
                     Intermediate Division:       8:30 to 10:00 a.m.
                     Senior Division:             10:00 to 11:00 a.m.

Categories of Competition:
                   Pools will be arranged by age, weight and rank.
                   1. Junior, intermediate and senior divisions
                   2. Masters Division upon request
                   3. Black Belt Division

Scoring System:      Place winners will be determined by wins first, then by points
                     as follows: Ippon 5, Waza-ari 4, Yuko 3, Koka 2, Decision 1

Awards:              Each pool will be awarded 1st, 2nd and 3rd place winners.

Entry Fees:           $30.00 Make checks payable to Albany Judo Club
                     $ 55.00 for 2 competitors from the same immediate family
                     $75.00 for 3 competitors from the same immediate family

Contest Rules:       Current IJF rules will govern this tournament
                     with the following exceptions:

                     No kansetsu-waza (armlocks) in divisions below black belt;
                     No shime-waza (chokes) below 13 years of age:

Officials Meeting: Meeting will be held at 9:30 a.m..

Tournament Director: DanAugustine 415 971-0885

Tournament Coordinator: Barry Wagner; Concessions: Ted Gempf; Offricial food: Mrs. Gempf
& Ms. Nakamura
                        Waiver, Warning and Release of Liability
                                Agreement to Participate

In consideration of being permitted to participate in any way, including travel to and from the 44tht
Annual Albany YMCA Judo Invitational, and related events and activities of the United States Judo Inc.,
United States Judo Federation, United States Judo Association, California Judo Inc.,. Central coast Judo
Association and Albany High School, I hereby:

1.       Acknowledge that I am familiar with the sport of Judo and understand the rules governing the
sport of Judo and the importance of following these rules.

2.       Agree that prior to participating, I will inspect the mates, equipment, facilities, competition pools
or divisions, and the elimination or scoring system to be used. If I believe anything is unsafe or beyond
my capability, I will immediately advise my coach or supervisor of such conditions and refuse to

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, and sever social and economic losses due to not
only my own action, inaction or negligence, but also the action, inaction or negligence of others, the rules
of the sport of judo, or the conditions of the premises or of any equipment used. Further I acknowledge
that there may be other risks not known to me or not reasonable foreseeable at this time.

4.      Knowing the risks involved in the sport of judo, I assume that risk and accept personal
responsibility for the damages following such injury, permanent disability or death.

5.       Release, waive and discharge and covenant not to sue California, Judo Inc., Central Coast Judo
Association, the United States Judo Inc., United States Judo Association, United States Judo Federation,
the Albany-Berkeley YMCA , the Albany Judo Club, Albany High School, together with their affiliated
clubs, their respective organizations, event officials, medical personnel, other participants, their parents,
guardians, supervisors and coaches, sponsoring agencies, sponsors, advertisers, and I hereinafter referred
to as “releases,” from any and all claims, demands, losses or damages on account of injury, including
permanent disability and death or damage to property, caused or alleged to be caused in whole or in part
by the negligence of the releases or otherwise.

6,       Parents or legal guardians of minor participants , age 16 or below, additionally agree that they
will instruct the minor participant to the above warnings and conditions and their ramifications, and that
they consent to minors participation.

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.

      Contestant                          Signature                         Date

        Parent or Guardian                Signature                         Date

To top