cz 4-3-12
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Fee Paid:
Sensei Sign:
Sensei Name:
AGE GROUPS Kata Kumite
Up to 7 yr Incl. Male & Female
8 to 9 yr Incl. Male & Female
10 to 11 yr Incl. Male
10 to 11 yr Incl. Female12 to 13 yr Incl. Male
12 to 13 yr Incl. Female
14 to 15 yr Incl. Male
14 to 15 yr Incl. Female
16 to 17 yr Incl. Male
16 to 17 yr Incl. Female
Jnr Open Black Belt Male (14 17 yrs)*
Jnr Open Black Belt Female (14 17 yrs)*
18 to 34 yr Incl. Male (up to 1st kyu)
18 to 34 yr Incl. Female (up to 1st kyu)
Open Black Belt Male (18 yrs+)**
Open Black Belt Female (18 yrs+)**
35 to 44 yr Incl. Male
35 to 44 yr Incl. Female
45 to 54 yr Incl. Male
45 to 54 yr Incl. Female
55 yr + Male
55 yr + Female
Instructors Male
Instructors Female
GRADE DIVISION
8th
to 7th
Kyu
6t, 5
t& 4
tKyu
3r
Kyu & Above
TEAM EVENTS
Junior Team Kata 8 4t
Kyu (under 18 yrs)
Junior Team Kata 3r
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 Kumite Team
1 1
2 2
3 3
4
5
NOTE: * 14 - 17 yrs Black Belts MUST enter Junior Open Division.
** 18 - 34 yrs Black Belts MUST enter Open Division.
** Both red & blue GKR /WKF mitts are required for Open division competitors
ENTRY FEES: 12.00 FIRST EVENT, 6 EACH SUBSEQUENT EVENT
Protective equipment is compulsory for Kumite
Note: GKR/IGKF or WKF certified RED or BLUE mitts are now COMPULSORY
for age groups 12/13 yrs & up. Either colour is acceptable except Opens div.> 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.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, its 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 thisincludes exclusion of liability for negligence (other than for death or personal injury) and all indirect or consequential loss or loss of profitsarising from participation in the tournament
Signature: Parents Signature:(If under 18 years of age)
Central Zone Regional TournamentSunday, March 4
th, 2012
Cocks Moors Woods Leisure Centre. Alcester Rd Sth, Birmingham B14 6ERPlease complete both pages of this form in full and pass it in to your local instructor along with the entry fee. Thank you!
ENTRY FORM
Name: Age at time of completion:
Address:
Region: Phone:
Dojo: Karate Grade:
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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 NOHave you been in contact with any contagious diseases in the last 3 months? YES NOAre you taking any form of medication at present? YES NOIf 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 / withouta 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 ananaesthetic to be administered or any other urgent medical treatment to be given on the advice of a qualifiedmedical practitioner / qualified first-aid officer.
Signed: Date:
Name (please print):
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GKR KARATE INTERNATIONALREGIONAL TOURNAMENT
Sunday, March 4, 2012
Cocks Moors woods Leisure CentreAlcester Rd South, Birmingham
8.00am: Competitor Check In
9.30am: Tournament Commences
Competitor Entry Fees: 12.00 first event, 6.00 each subsequent eventSpectators: Adult 5, Child 3, Family 12 (children under 5 years free)
Closing date for entries: Sunday, February 26, 2012(5 late fee will apply)
NO ENTRIES WILL BE ACCEPTED ON THE DAYAll fees are strictly non refundable
Competitors Safety EquipmentNote: GKR/IGKF or WKF certified RED or BLUE mitts are now COMPULSORY for age groups
12/13 years & above. Either colour is acceptable, except in Open divisions where competitors
will require both colours.
Mouth guards and standard white shin protectors, are compulsory.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.