Stamford Judo

100 Research Drive
2nd Floor
Stamford, CT 06906
ph: 203-327-6665
fax: 203-286-2356
alt: 203-253-2008
chrisangle@sbcglobal.net

Entry Forms for Classic Rules Judo

Send to: Classic Rules Judo Championships
        P.O. Box 708
        Redding, CT 06896 U.S.A.

NAME_________________________ AGE__________

ADDRESS_______________________________________________________

            _______________________________________________________

NAME OF CLUB______________________________________________________

WEIGHT DIVISION____________________OPEN DIVISION - YES/NO

CHECK ENCLOSED__________________

IF BY CREDIT CARD, CC #_______________________________________

EXPIRY DATE_______________

SIGNATURE_____________________________________________________

Credit Card Payments will be billed by Stamford Judo
website: www.stamfordjudo.us

Classic Rules Judo Championships

Mailing Address: P.O. Box 708 Redding, CT 06896 U.S.A.

Direct Inquiries to Chris Angle
Tel. 203/406-3915
Fax. 203/286-2356
Email: chrisangle1@gmail.com

WAIVER AND RELEASE OF LIABILITY AND AGREEMENT TO PARTICIPATE

In consideration of being permitted to participate in any way, including travel to and from, in any judo tournament, practice, clinic, and related events and activities of U. S. Judo Association (USJA), U.S. Judo Federation (USJF), USJI, Stamford Judo, Classic Rules Judo Championships, Inc., I hereby:

1.     Acknowledge that I am familiar with the sport of Judo and understand the rules governing the sport of Judo.
2.     Agree that prior to participating, I will inspect the mats, equipment, facilities, competition pools or divisions and the elimination or scoring system to be used, and if I believe anything is unsafe or beyond my capability, I will immediately advise my coach, supervisor, and/or a tournament official of such conditions and refuse to participate.
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 severe social and economic losses due to not only my own actions, inactions, or negligence, but also to the actions, inactions, or negligence of others, the rules of the sport of Judo, or conditions of the premises or
of any equipment used. Further, I acknowledge that there may be other risks not known to me or not reasonably foreseeable at this time.
4.     Knowing the risks involved in the sport of Judo, I assume all such risks and accept personal responsibility for the damages following such injury, permanent disability, or death.
5.     Release, waive, discharge and covenant not to sue the U. S. Judo Association (USJA), U.S. Judo Federation (USJF), USJI, Stamford Judo, Classic Rules World Judo Championships, Inc. together with their affiliated clubs, their respective administrators, directors, agents, coaches and other employees or volunteers of the organization, event officials, medical personnel, other participants, their parents, guardians, supervisors and coaches, sponsoring agencies, sponsors, advertisers, and if applicable, owners, lessors, and lessees of premises used to conduct the event, all of whom are hereinafter referred to as "releasee", from any and all claims, demands, losses, or damages on account of injury, including permanent disability and death and damage to property, caused or alleged to be caused in whole or in part by the negligence of the releasee or otherwise to the fullest extent permitted by law.

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 RISK AND CONDITIONS INVOLVED AND DO SO ENTIRELY OF MY OWN FREE WILL. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENT/GUARDIAN AS EVIDENCED BY THEIR SIGNATURE BELOW.

___________________________
Participant's Printed Name

___________________________
Participant's Signature

___________
Date

FOR PARENTS/GUARDIANS OF PARTICIPANTS WHO ARE MINORS (UNDER AGE 18 AT TIME OF REGISTRATION)

This is to certify that I, as parent/guardian with legal responsibility for This participant, do consent and agree to his/her release, as provided above, of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child's involvement or participation in these programs as provided above, even if arising from their negligence, to the fullest extent permitted by law. I have instructed the minor participant as to the above warnings and conditions and their ramifications.

_____________________________
Parent/Guardian's Printed Name

____________________________
Parent/Guardian's Signature

____________
Date

CERTIFICATE REGARDING NON-BLACK BELT PARTICIPANTS

I, (Name of Instructor) _______________________________________________ a Judo black belt instructor who has been awarded the Dan Rank of

___________________________________ by (Name of Organization)

__________________________________________________,

certify that (Name of Contestant)

____________________________________________________although not having been awarded the rank of Shodan or higher, is of sufficient aptitude and skill in Judo to participate in this event.

_________________________
Instructor Name (Please Print)

_______________________
Instructor Signature               Date ________

1. Players less than 18 years of age require approval of the Tournament Director to compete.
2. Include email address if you want to have a confirmation sent to you.

Send by Postal Mail to address above or via E-mail to:

chrisangle1@gmail.com

APPLICATION FOR REFEREES AND VOLUNTEERS

We seek volunteers to make the Classic Rules Judo Championships event run smoothly.

Please complete this application in full. We appreciate the time you take to assist in making the Classic Rules Judo Championships a success.

Classic Rules Judo Championships
        P.O. Box 708
        Redding, CT 06896 U.S.A.
Telephone: (203) 409-3915
Fax: (203) 286-2356
E-mail: chrisangle1@gmail.com

Volunteer as Referees or Volunteers

First Name:____________________Family Name:__________________

Street Address:_______________________________

City:____________________________Province/State:_________________

Zip/Postal Code:________________Country:______________________

Email:______________________________________

Referee               Volunteer- Timekeepers:

Volunteer- Recorders:       Volunteer – Other:

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100 Research Drive
2nd Floor
Stamford, CT 06906
ph: 203-327-6665
fax: 203-286-2356
alt: 203-253-2008
chrisangle@sbcglobal.net