Entry Form - Shotokan Karate International

Shotokan Karate International Australia 

National Kyu Grade Championship 

Entry Form 

OFFICE USE ONLY: Date-R: Authorised: ID: 

PLEASE READ THE FOLLOWING NOTES 

• Complete Sections A, B, C & D of the entry form. 

• The rank of 3 rd kyu and above is permitted to compete in the open 

tournament 

• Kyu grades (3, 2, 1) must have competed in the National Kyu Grade 

Tournament to qualify for entry. 

• Juniors are defined as being competitors aged 15 years and younger. 

• Colts are defined as being competitors aged 16-18 years. 

• Seniors are defined as being competitors aged 18 years and older. 

• Veterans are defined as being competitors aged 40 years and older. 

• Ages are taken as at 31 st December, 2010. 

• Events may change, be combined or altered at the discretion of SKIA 

Victoria. 

SECTION A: COMPETITOR DETAILS 

Surname:______________ 

First Name:_____________ Age (as at 31/12/10):_______ 

Sex (M/F):______________ Weight (kgs):____________ D.O.B:_______________ 

State:_________________ Dojo:__________________ Grade:_______________ 

SECTION B: TOURNAMENT ENTRY FEES POSTAL DETAILS 

Adults (18 years and above) $ 30.00 $ ________________ 

Children (17 years and below) $ 20.00 

$ ________________ 

Please make all cheques or money orders payable to SKIA Victoria, and mail to: 

SKIA Victoria 

C/- Jeremy de Vos 

P.O. Box 455, Emerald 

VIC., 3782 

NOTE: Tournament entry forms will not be accepted after Friday, August 27 th , 2010. 

Tournament entry forms are non-refundable.

SECTION C: COMPETITION EVENTS 

Please tick the events you wish to enter 

J U N I O R K A T A 

No Event Grades Eliminations Finals 

1 

2 

3 

4 

5 

6 

7 

8 

C O L T S K A T A 

Junior Individual Mixed Kata 

11 years and under 


12 to 15 years 









Junior Team (3) Mixed Kata 

11 yrs & under (one per state) 

Junior Team (3) Mixed Kata 

12 to 15 years (one per state) 

10,9,8,7 Kyu Heian Shodan Heian 1 or 2 

10,9,8,7 Kyu Heian Shodan Heian 1 or 2 

6,5,4 Kyu Heian 1,2,3 Heian 2,3 or 4 

6,5,4 Kyu Heian 1,2,3 Heian 2,3 or 4 

3,2,1 Kyu 

3,2,1 Kyu 

Heian 2,3,4,5 Tekki 

Shodan 


Shodan 

Kyu Grades One round only Tokui 

Kyu Grades One round only Tokui 

Tokui (Heian 4,5, Tekki 

Shodan, Bassai Dai, Jion, 

Kanku Dai, Enpi) 





9 Individual Mixed Kata 10,9,8,7 Kyu Heian Shodan Heian 1 or 2 

10 Individual Mixed Kata 6,5,4 Kyu Heian 1,2,3 Heian 2,3 or 4 

11 

Female Individual Mixed 

Kata 

3,2,1 Kyu 

12 Male Individual Mixed Kata 3,2,1 Kyu 

13 


Shodan 


Shodan 

Team (3) Mixed Kata (one per 

state) Kyu Grades One round only Tokui 

S E N I O R K A T A 








14 Senior Individual Mixed Kata 10,9,8,7 Kyu Heian Shodan Heian 1 or 2 

15 Senior Individual Mixed Kata 6,5,4 Kyu Heian 1,2,3 Heian 2,3 or 4 

16 

17 

Female Senior Individual 

Mixed Kata 

Male Senior Individual Mixed 

Kata 

3,2,1 Kyu 

3,2,1 Kyu 


Shodan 


Shodan 






Kanku Dai, Enpi)

18 

19 

20 

21 

22 

Female Masters Individual 

Mixed Kata 40 to 49 years Kyu Grades Tokui Tokui 

Male Masters Individual 


Female Masters Individual 


Male Masters Individual 


Senior Team (3) Mixed Kata 

One per state Kyu Grades Tokui Tokui 

J U N I O R K U M I T E 

Karateka who hold sixth Kyu & above may compete in Jiyu Kumite 


23 

Mixed Gohon Kumite 11 

years and under 

7,8,9,10 Kyu 

Jodan & Chudan 


24 

Mixed Gohon Kumite 12-13 

years 

7,8,9,10 Kyu 



25 

Mixed Gohon Kumite 14-15 

years 

7,8,9,10 Kyu 



26 

Mixed Kihon Ippon Kumite 11 


6,5,4 Kyu 

Jodan, Chudan & 

Mae Geri 

Jodan, Chudan & Mai 

Geri 

27 

Mixed Kihon Ippon Kumite 

12-13 years 6,5,4 Kyu 


Mae Geri 

Jodan, Chudan & Mae 

Geri 

28 

Mixed Kihon Ippon Kumite 

14-15 years 6,5,4 Kyu 


Mae Geri 


Geri 

29 

30 

31 

32 

33 

34 

35 

36 

37 

40 

41 

Girls’ Jiyu Ippon Kumite 11 


Girls’ Jiyu Ippon Kumite 12- 

13 years 

Girls’ Jiyu Ippon Kumite 14- 

15 years 

Boys’ Jiyu Ippon Kumite 11 


Boys’ Jiyu Ippon Kumite 12- 

13 years 

Boys’ Jiyu Ippon Kumite 14- 

15 years 

Girls’ Jiyu Kumite 11 years 

and under 

Girls’ Jiyu Kumite 12-13 

years 


years 

Boys’ Jiyu Kumite 11 years 

and under 

Boys’ Jiyu Kumite 12-13 

years 

3,2,1 Kyu 

3,2,1 Kyu 

3,2,1 Kyu 

3,2,1 Kyu 

3,2,1 Kyu 

3,2,1 Kyu 

6,5,4 Kyu 

6,5,4 Kyu 

6,5,4 Kyu 

6,5,4 Kyu 

6,5,4 Kyu 

Jodan, Chudan, Mae 

Geri Kekomi & 

Mawashi Geri 


Geri Kekomi & 

Mawashi Geri 


Geri Kekomi & 

Mawashi Geri 


Geri Kekomi & 

Mawashi Geri 


Geri Kekomi & 

Mawashi Geri 


Geri Kekomi & 

Mawashi Geri 

Ippon Han 

Ippon Han 

Ippon Han 

Ippon Han 

Ippon Han 


Geri Kekomi & Mawashi 

Geri 



Geri 



Geri 



Geri 



Geri 



Geri 

Ippon Han 

Ippon Han 

Ippon Han 

Ippon Han 

Ippon Han

42 

43 

44 

45 

46 

47 

48 


years 

Girls’ Jiyu Kumite 11 years 

and under 


years 


years 

Boys’ Jiyu Kumite 11 years 

and under 


years 

6,5,4 Kyu 

3,2,1 Kyu 

3,2,1 Kyu 

3,2,1 Kyu 

6,5,4 Kyu 

6,5,4 Kyu 

Ippon Han 

Ippon Han 

Ippon Han 

Ippon Han 

Ippon Han 

Ippon Han 

Ippon Han 

Ippon Han 

Ippon Han 

Ippon Han 

Ippon Han 

Ippon Han 


years 6,5,4 Kyu Ippon Han Ippon Han 

C O L T S 

K U M I T E Karateka who hold sixth Kyu & above may compete in Jiyu Kumite 


49 

Female Colts’ Gohon 

Kumite 

7,8,9,10 Kyu 



50 

Male Colts’ Gohon Kumite 

7,8,9,10 Kyu 



51 

Colt’s Female Kihon Ippon 

Kumite 

6,5,4 Kyu 


Mae Geri 


Geri 

52 

Colt’s Male Kihon Ippon 

Kumite 

6,5,4 Kyu 


Mae Geri 


Geri 

53 

54 

Colt’s Female Jiyu Ippon 

Kumite 

Colt’s Male Jiyu Ippon 

Kumite 

3,2,1 Kyu 

3,2,1 Kyu 


Geri Kekomi & 

Mawashi Geri 


Geri Kekomi & 

Mawashi Geri 


Geri Kekomi & 

Mawashi Geri 


Geri Kekomi & 

Mawashi Geri 

55 Colt’s Female Jiyu Kumite 3,2,1 Kyu Ippon Han Ippon Han 

56 Colt’s Male Jiyu Kumite 3,2,1 Kyu Ippon Han Ippon Han 

57 Colt’s Female Jiyu Kumite 6,5,4 Kyu Ippon Han Ippon Han 

58 Colt’s Male Jiyu Kumite 6,5,4 Kyu Ippon Han Ippon Han

S E N I O R K U M I T E 

Karateka who hold sixth Kyu & above may compete in Jiyu Kumite 


59 

Female Gohon Kumite 

7,8,9,10 Kyu 



60 

Male Gohon Kumite 

7,8,9,10 Kyu 



61 Female Kihon Ippon Kumite 6,5,4 Kyu 

62 Male Kihon Ippon Kumite 6,5,4 Kyu 

63 Female Jiyu Ippon Kumite 3,2,1 Kyu 

64 Male Jiyu Ippon Kumite 3,2,1 Kyu 

65 

66 

67 

68 


Mae Geri 


Mae Geri 


Geri Kekomi & 

Mawashi Geri 


Geri Kekomi & 

Mawashi Geri 

Male Masters Jiyu Kumite 

40-49yrs 6,5,4 Kyu Ippon Han Ippon Han 







69 Female Jiyu Kumite 6,5,4 Kyu Ippon Han Ippon Han 


Geri 


Geri 

Jodan, Chudan, Mae Geri 

Kekomi & Mawashi Geri 

Jodan, Chudan, Mae Geri 

Kekomi & Mawashi Geri 

70 Male Jiyu Kumite 3,2,1 Kyu Ippon Han Ippon Han 

71 Female Jiyu Kumite 6,5,4 Kyu Ippon Han Ippon Han 

72 Male Jiyu Kumite 3,2,1 Kyu Ippon Han Ippon Han

SECTION D: CONDITIONS OF ENTRY AND PARTICIPATION IN TOURNAMENT 

1. In these conditions: “the Association” shall mean and include Shotokan Karate International 

Australia Inc. and Shotokan Karate International Australia Inc. Victoria, its officers, servants or 

agents. “Opponent” shall mean any person competing against the competitor. 

2. In consideration of the Association accepting my application to enter and compete in the 

tournament and in further consideration of my opponent competing against me, I hereby agree to 

abide by the conditions of entry, the rules, by-laws and regulation of the Association. 

3. The Association enters into this contract as the Association and as agent for the competitor’s 

opponent. 

4. I acknowledge that my participation in the tournament carries with it a real risk of personal injury. 

5. I acknowledge and agree that the Association shall not be liable whether in tort or contract or 

otherwise for any loss or damage or injury whatsoever to my person or property whilst 

participating in or otherwise attending the tournament, howsoever caused or occurring including 

without limiting the forgoing, the negligence, breach of contract, willful act or default of the 

Association and whether or not such loss or damage or injury occurs within or adjacent to any 

property occupied by the Association. 

6. I acknowledge and agree that my opponent shall not be liable whether in tort or in contract or 

otherwise for any loss or damage or injury whatsoever to my person or property whilst 

participating in or otherwise attending the tournament, howsoever caused or occurring including 

without limiting the forgoing, the negligence, breach of contract, willful act or default of my 

opponent and whether or not such loss or damage or injury occurs within or adjacent to any 

property occupied by the Association. 

7. I authorize the Association to contract on my behalf to exclude my liability as an opponent 

whether such arises in tort or in contract or otherwise for any loss or damage or injury to another 

competitor however caused or occurring including but limiting the forgoing, the negligence, 

breach of contract, willful act or default by myself. 

8. I expressly agree to and do hereby waive any rights that I may have which are in any way 

inconsistent with the foregoing. 

Competitor’s Signature: _____________________________________ 

Date:____________ 

To be completed by parent / guardian (if under 18 years of age). 

I _______________________________ being the parent / guardian of _________________________ 

confirm that my child is a minor. 

In consideration of the Association in accepting my child’s application to enter and compete in the 

tournament I severally agree to indemnify the Association against any claims, suits or demands of any 

nature whatsoever whether in tort or contract or otherwise for any loss or damage or injury whatsoever to 

my child however caused or occurring without limiting the forgoing, the negligence, breach of contract, 

willful act or default of the Association or my child’s opponent, arising out of or in the course of my 

child’s entry into or participation in this competition. 

Parent / guardian’s name: _____________________________________ 

Date:____________ 

Parent / guardian’s signature: __________________________________ 

Date:____________ 

In the event that any provision or part of a provision of these conditions is held or found to be void, 

invalid or otherwise unenforcable it shall be deemed to be served from the conditions to the extent of such 

invalidity or uneforcability but the remainder of the conditions shall remain in full force and effect. 

PLEASE MAKE SURE YOU HAVE CORRECTLY FILLED IN SECTIONS A, B, C & D OF THIS FORM

Entry Form - Shotokan Karate International

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