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The 14th US Open Masters TaeKwonDo Championship COMPETITOR’S REGISTRATION FORM

Please submit this form along with your participation fee(NON-REFUNDABLE)
Registration Deadline, October 21, 2017

Please submit this form along with your participation fee(NON-REFUNDABLE)
Registration Deadline, October 21, 2017

NO REGISTRATION APPLICATIONS WILL BE ACCEPTED AFTER October 21, 2017


* First Name Last Name
Gender*  
Date of Birth*
Age*
Weight * lbs
Height*
Belt*
Dan*
Address* Street Address
* Area Code Phone Number
Work Phone Area Code Phone Number
T.K.D School*
WTF
 
**If for any reason the application & payment cannot be submitted online please mail directly to YITKD
227 Dayton Ave, Clifton, NJ 07011
Tel: 973-340-1717 / Fax: 973-340-1328 / Email: info@tkdbuy.com
 
Medical Questionnaire Form *
Please check either (Y) for yes or (N) for no.
1. Do you have any allergies to medication ?
2. Do you take any medication regularly ?
3. Do you wear contact lenses ?
4. Do you have a history of:
PLEASE READ CAREFULLY !
I hereby certify that the above information is true and accurate to the best of my knowledge and hereby agree that I WILL NOT be permitted to participate in this tournament if this MEDICAL QUESTIONNAIRE FORM is not completed and returned prior to the tournament to YITKD
227 Dayton Ave, Clifton, NJ 07011
Tel: 973-340-1717 / Fax: 973-340-1328 / Email: info@tkdbuy.com
CERTIFICATION:
Home Phone
Liability Waiver

I UNDERSTAND THAT TAEKWONDO IS A PHYSICAL CONTACT SPORT WHICH INVOLVES THE RISK OF INJURY. I AGREE THAT I WILL BE RESPONSIBLE FOR ALL CASE OF ACCIDENTS SUCH AS ANY DAMAGE, LOSS AND ANY INJURY ETC. WHICH OCCURRED DURING PHYSICAL EXERCISE AND COMPETITION OF DEMONSTRATION TILL THE FINISH OF THE TOURNAMENT. I AGREE THAT THE ORGANIZING COMMITTEE FOR THE 14th US Open Masters TAEKWONDO CHAMPIONSHIP INCLUDING ORGANIZERS, OFFICIALS, STAFF AND VOLUNTEERS AS WELL AS REFEREES, MASTERS, INSTRUCTORS, COACHES, FELLOW COMPETITORS, STAFF EXCEPT COMPETITOR HERSELF/HIMSELF WILL BE INDEMNIFIED FROM ALL ACCIDENTS AS ABOVE AND RELEASE AND FOREVER DISCHARGE FROM ANY CLAIMS FOR DAMAGES. I, ALSO AGREE THAT THE MEDICAL TREATMENT PROVIDED BY THE ORGANIZING COMMITTEE, IF NECESSARY WILL BE A FIRST AID TYPE ONLY. IN CONSIDERATION OF THE PRIVILEGE OF PARTICIPATING IN THE COMPETITION IN The 14th US Open Masters TAEKWONDO CHAMPIONSHIP, FOR MYSELF AND MY HEIRS, CHILDREN, PARENTS, GUARDIANS, EXECUTORS, PERSONAL REPRESENTATIVES, ASSIGNS AND ADMINISTRATORS, I FOREVER RELEASE, ACQUIT, WAIVE DISCHARGE, AND COVENANT NOT TO SUE COLONIA HIGH SCHOOL, THE BOARD OF EDUCATION OF WOODBRIDGE TOWNSHIP SCHOOL DISTRICT NEW JERSEY, THE YONG IN TAEKWONDO CENTER, THE UNITED STATES OLYMPIC COMMITTEE, IMA, OR ANY OF THE ORGANIZERS, VOLUNTEERS, SPONSORS, AFFILIATED ORGANIZATIONS, COACHES, INSTRUCTORS, MANAGERS, TRAINERS, OR DOCTORS, OR ANY OTHER PERSONS, OR ORGANIZATION INVOLVED IN The 14th US Open Masters TAEKWONDO CHAMPIONSHIP, OR ANY OF THEIR REGENTS, DIRECTORS, OFFICERS, MANAGERS, EMPLOYEES, AGENTS, AFFILIATES, ATTORNEYS, SPOUSES, HEIRS, EXECUTORS, ADMINISTRATORS, SUCCESSORS, OR ASSIGNS. IF YOU ARE UNDER 18 YEARS OLD, YOU MUST HAVE A PARENT OR GUARDIAN'S ACKNOWLEDGMENT AND AGREEMENT HERE WITHIN.

 

*
If you are a minor (under 18 years old) and will be at the tournament without a parent, the statement below must be read and signed by a parent or legal guardian and returned prior to participating in any competition or event. The undersigned competitor, (parent or legal guardian of the competing minor) represents that he has the authority to consent to the medical care and treatment of such a competitor (or competing minor) by the designees of YITKD.
Payment Information
Credit Card Information

(VISA,MASTER,DISCOVERY, AMEX)

Total*
Card Number* Security 3 digit Code
Valid Date* MM YYYY  
Name on Card*
Billing Address*

Processing will take approximatly 30 seconds. Please just wait until it's done.

After You Have Submitted, You Must check in your email that your name tag has been confirmed.



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227 Dayton Ave, Clifton, NJ 07011
Tel: 973-340-1717 / Fax: 973-340-1328 / Email: tkdbuy@yahoo.com

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