EWK Samurai Classic

Junior Black Belts

$55.00

For 1st Division Choose One: *

Choose Additional Divisions ($10.00):

Competitor Name *

DOB (Format: M/D/Y) *

Gender *

Age (on Jan 1/19): *

Weight (LBS) *

Current Belt Colour *

Club Name *

Phone Number *

Email Address: *

Head Instructor *

WAIVER: *

We the undersigned, hereby voluntarily submit our application to compete at the 2019 SAMURAI CLASSIC ONTARIO OPEN MARTIAL ARTS CHAMPIONSHIPS and do hereby waive any and all rights, claims or action that we, our heirs, successors or assigns may have against the Samurai Classic Ontario Open Martial Arts Championships, Christina Magliocco, East West Karate, Mentor College, or any agents, employees of the event, for damages or any form of recovery from liability resulting from injuries that may incur as a result from our participation and or attendance at said event. We further agree to indemnify any and all of the above parties in any action based on our attendance and or participation at the Samurai Classic Ontario Open Martial Arts Championships. We have read, understand and agree to abide by the rules associated with this event and assume all responsibility and any associated liability for infringement of such rules. Additionally we are fully aware of our personal medical condition and hereby certify that we are mentally and physically fit to compete at said event. We reserve the right to deny entry to anyone. * A $5.00 online payment processing handling fee has been added.