E-Mail Address (required)
|
First and Last Name (required)
|
ATA Number (required)
|
Date of Birth (required)
|
Age (required)
|
Gender (required)
Male
Female
|
Rank (required) :
|
Competition Age (required)
|
Competition Rank (required) :
|
|
|
|
Please Select Event Entering (Seperate Form for Each Event) |
Forms and Sparring / One-Steps
|
Traditional Weapons
|
ATA Xtreme Forms
|
ATA Xtreme Weapons
|
Creative Forms
|
Creative Weapons
|
Combat Weapons
|
TINY TIGERS ONLY: |
Whole Form or Half of Form
Whole Form
Half of Form
|
Name of Form
White Belt
Songham 1
|
Is Help Needed
Yes
No
|
Competing in One-Steps
Yes
No
|
Terms and Conditions |
I have applied to participate in the ATA Champaign, IL Regional Tournament, I understand
that by registering in this tournament that I am subjecting myself to possible injury as I am voluntarily engaging in a contact sport.Before signing the application to register, I was given an opportunity to ask any questions that I may have had relating to any danger or harm that I could be exposed to, and I have either asked the questions or have chosen not to ask. |
By enrolling in this tournament I understand it is my responsibility to learn and understand all
safety procedures and rules related to involvement in the ATA Taekwondo Program. These procedures and rules apply not only to my training but also to participation in this tournament. |
As part of the agreement in allowing me to participate in this tournament, I agree that the
American Taekwondo Association® and its affiliates (including their officers, employees, agents, tournament organizers, and any other student), will not be responsible for my safety nor do any of these parties assume my as a guardian or as a fiduciary. This specifically means that no one listed in this paragraph or associated with American Taekwondo Association® will be held liable for any injury, death, or any other damages caused to me or to my family, decedents, heirs or anyone assuming any rights on my behalf, and I specifically waive any claim I may have against such persons or individuals. |
As further consideration and as a bias for allowing me to participate in this tournament, I
agree to assume any and all risk of harm, and I specifically agree to release the American Taekwondo Association and its affiliates (including anyone connected with this tournament) as it relates to any damage, harm or injury that I may suffer, even if the event causing the damage, harm or injury was foreseeable or if such damage, harm or injury was created or caused by the negligent act of the parties I am releasing (this release will not apply to any intentional act). This agreement to hold harmless shall apply to any claim by me or my family, including my estate, heirs, or any personal representatives in the event of my death for any damage, injury or harm that should occur by my participation in any training, tournament, summer camp, or other program related to this participation in American Taekwondo Association®. |
I state that I am of legal age (at least 18 years of age) and that no court has declared that
I cannot sign such documents. I understand that this is a binding agreement and that I am waiving certain rights, and I know before signing this I have the right to have it reviewed by an attorney. |
I have read this agreement and I understand what it means. I represent that I am in good
health and that I assume responsibility for my continued physical condition and capability to participate in the ATA Taekwondo training and related activities. |
Do you are agree to the terms and conditions of this tournament? (required)
Yes
No
|
TO BE AGREED TO IF ABOVE IS EXECUTED BY PARENT OR LEGAL GUARDIAN |
As the parent and/or guardian of the person named above we hereby wish to register
a minor in the ATA Champaign, IL Regional Tournament and after reading the above terms and conditions, do hereby agree to the terms set forth above on behalf of the minor named herein. Since the person named above is a minor and I have agreed to the terms set forth above, I hereby agree to indemnify and save harmless the American Taekwondo Association® and its affiliates (including anyone connected with these organizations) for any harm caused to the minor or should the minor later bring an action against any of the parties. I understand that I have agreed to pay any costs relating to any claim against the above named persons (including legal fees to defend such action) and to pay any award of damages should one be made in favor of the minor against any of the parties. As further consideration for allowing the minor to enroll in the tournament I personally waive (give up) any claim or cause of action that I may personally have as the parent or legal guardian in the event of any harm, injury, or damage. |
Medical Release
I on behalf of the above minor, hereby give permission to any licensed physician and/or hospital to provide emergency medical treatment which may be necessary due to any injury or accident incurred while participating in the ATA Champaign, IL Regional Tournament. I agree to be responsible for all costs related to such medical treatment. |
By checking the box the parent and/or guardian of the minor agree to the terms and medical release.
|
Medical Information |
|
|
Medical Insurance Coverage (required)
|
Policy Number (required)
|
Identification Number (required)
|
Indicate any restrictions to treatment and/or allergies to medications:
|
After clicking submit you'll be given the chance to make an online payment. |
Processing ....
