|
"Black Belts are Ordinary People with
EXTRA-ordinary Determination"
|
|
|
|
March 18-19 National Championships Albuquerque, NM
![]()
2005 Battle of the Champions January 15th, Fontainebleau High School
Other Upcoming Events
----------------------------------------------------------------- cut here ---------------------------------------------------------------- Application to Compete – 2005 Battle of the Champions January 15th, 2005 - Fontainebleau High School $35 Entry Fee (Forms and/or Sparring) $5 Extra (weapons) $5 discount with current U.S. Karate Alliance membership card Make checks payable to: Joe Dupaquier
Events (circle each): Sparring Forms Weapons Name:____________________________________ Age:____ Date of birth:__________ Rank:________________Address:_________________________________________ City:___________________ State:____ Zip:________ Notice: this agreement contains indemnity and release provisions. In submitting said application, the undersigned hereby gives permission for the contestant to participate in said Battle of the Champions to be held at the Fontainebleau High School, Mandeville, Louisiana on January 15th, 2005. Acting for myself, or as the parent or legal guardian for the contestant, I do hereby assume all risk of injury to said contestant while participating in and traveling both to and from said Battle of the Champions, and acting for myself, my heirs, personal representatives and assigns, do hereby release Fontainebleau High School, St. Tammany Parish School Board, Joe Dupaquier Jr., the tournament directors, United States Karate Alliance, and associations, the officers, agents, employees and representatives of said organizations and any and all competitors and fellow participants, individually and collectively, from any liability (now and forever). As a parent or legal guardian, I agree to indemnify any such organization for any loss or expense by reason of any claim by child or ward.
Date_____ Signature of Contestant (or Guardian if under 18) ___________________________________________
|