NSW Regional Tourn 2.. - GKR Karate

NSW Regional Tournament
Sunday, May 26, 2013
Ryde Community Sports Centre. Kent Rd, North Ryde.
ENTRY FORM
Please complete both pages of this form in full and pass it in to your local instructor along with the entry fee. Thank you!
Name:
Age at time of competition:
Address:
Region:
Dojo:
Phone:
Karate Grade:
AGE GROUPS Kata Kumite
Up to 7 yr Incl. Male & Female 1 1
8 to 9 yr Incl. Male & Female 2 2
10 to 11 yr Incl. Male 3 3
10 to 11 yr Incl. Female 4 4
12 to 13 yr Incl. Male 5 5
12 to 13 yr Incl. Female 6 6
14 to 15 yr Incl. Male 7 7
14 to 15 yr Incl. Female 8 8
16 to 17 yr Incl. Male 9 9
16 to 17 yr Incl. Female 10 10
Jnr Open Black Belt Male (14 – 17 yrs)* D03 D03
Jnr Open Black Belt Female (14 – 17 yrs)* D04 D04
18 to 34 yr Incl. Male (up to 1st Kyu) 11 11
18 to 34 yr Incl. Female (up to 1st Kyu) 12 12
Open Black Belt Male (18 yrs+)** D01 D01
Open Black Belt Female (18 yrs+)** D02 D02
35 to 44 yr Incl. Male 13 13
35 to 44 yr Incl. Female 14 14
45 to 54 yr Incl. Male 15 15
45 to 54 yr Incl. Female 16 16
55 yr + Male 17 17
55 yr + Female 18 18
Instructors Male D05 D05
Instructors Female D06 D06
GRADE DIVISION
8 th to 7 th Kyu A
6 th , 5 th & 4 th Kyu B
3 rd Kyu & Above C
TEAM EVENTS
Junior Team Kata 8 – 4 th Kyu (under 18 yrs)
Junior Team Kata 3 rd Kyu+ (under 18 yrs)
Team Kata Male (18+ yrs)
Team Kata Female (18+ yrs)
Male Team Kumite (18+ yrs)
Female Team Kumite (18+ yrs)
TEAM NAMES
Kata Team
1 1
2 2
3 3
Kumite Team
4
5
NOTE:
* 14 - 17 yrs Black Belts MUST enter Junior Open Division.
** 18 - 34 yrs Black Belts MUST enter Open Division.
ENTRY FEES: $20.00 FIRST EVENT, $10.00 EACH SUBSEQUENT EVENT
Protective equipment is compulsory for Kumite
Hand Mitts, Shin protectors & Mouth Guards must be worn by all competitors.
Groin guards for all male competitors is compulsory.
Chest protectors are compulsory for all female competitors from 12 years.
Fee Paid:
Sensei Sign:
Sensei Name:
GKR KARATE INTERNATIONAL TOURNAMENT DECLARATION
1. I am aware that participation in martial arts, including non-contact GKR tournaments, as with most sports contains a risk of injury.
2. In consideration of my acceptance in the competition, I agree that GKR Karate, it’s servants and agents and all persons involved in the
organisation of the tournament shall be excluded from liability for loss and damage to the fullest extent permitted by law. I accept that this
includes exclusion of liability for negligence (other than for death or personal injury) and all indirect or consequential loss or loss of profits
arising from participation in the tournament
Signature:
Parents Signature:
(If under 18 years of age)

Name:
D.O.B:
Address:
Post Code:
Phone Number:
Other Number:
Please circle YES or NO to the following questions and statements.
Do you have any allergies? e.g. aspirin; antibiotics; foods? YES NO
Have you been in contact with any contagious diseases in the last 3 months? YES NO
Are you taking any form of medication at present? YES NO
If the answer is YES to any of these questions, please give details:
Doctors Details:
Name:
Phone Number:
Address:
Emergency Contact Details:
Please give two contact numbers where someone can be contacted in the event of an emergency
1. Name: Relationship:
Phone Number:
Other Number:
2. Name: Relationship:
Phone Number:
Other Number:
Declaration (Delete as applicable)
I / My son / daughter is capable of taking part in the GKR Karate Tournament. I am willing to allow my son /
daughter to participate in the above activity and confirm that they will be attending the tournament with / without
a parent / guardian / a nominated person who has agreed to supervise my child. In the event of illness or injury,
I agree to authorise members of staff attending / participating in the event to consent on my behalf for an
anaesthetic to be administered or any other urgent medical treatment to be given on the advice of a qualified
medical practitioner / qualified first-aid officer.
Signed:
Date:
Name (please print):

GKR KARATE INTERNATIONAL
REGIONAL TOURNAMENT
Sunday, May 26, 2013
Ryde Community Sports Centre
Kent Rd,
North Ryde
8.30am: Competitor Arrival
9.00am: Tournament Commences
Competitor Entry Fees: $20.00 first event, $10.00 each subsequent event
Spectators: Adult $8, Child $4, Family $20 (children under 5 years free)
Closing date for entries: Sunday, May 12, 2013
($10 late fee will apply)
NO ENTRIES WILL BE ACCEPTED ON THE DAY
All fees are strictly non refundable
Competitors Safety Equipment
Mouth guards, shin protectors, and hand mitts are compulsory for all competitors
Chest protectors are compulsory for all female competitors 12 years+
Groin Protectors are compulsory for all male competitors
NB: 1. Competitor to keep this page for tournament details.
2. Competitor must hand in entry form along with fees
to instructor.