Last Name:  

  (Required)                               

First Name:  

  (Required)   

IFMA #:  

Address:  

City:  

State:  

Zip:  

Email Address:  

  (Required)   

Date of Birth (mm/dd/yyyy):   

Belt Color:  

Rank:  

MA School:  

Team:   

T-Shirt Size:   

Divisions:

           

I the above registered competitor do hereby waive any and all rights or claims I may have against Ron Cain, Diane Cain, Cain’s Taekwondo Academy LLC, Holiday Inn, the International Federation of Martial Arts (IFMA), the National Blackbelt League (NBL), the Super Grands World Games, the Amateur Internationals, Sport Karate International (SKIL), Sport Karate International Tournament Alliance (SKITA), SMASH Publications, Bonsai Budo Karate, Boice Lydell, all NBL & IFMA tournament promoters, all NBL & IFMA sanctioned tournaments and all their agents, servants & employees, & I hereby release & discharge them from any & all claims resulting from injuries, including death, damages or loss, which may accrue to me or my heirs arising out of or in any way connected with my attendance &/or participation at any NBL or SKIL sanctioned event. I represent & warrant that I am physically & mentally fit, able to participate, & I do hereby assume responsibility for my own well-being, understanding that participation involves bodily contact. I have read, understand & agree to abide by the Sport Karate International Tournament Alliance (SKITA) rules associated with NBL/SKIL events & assume all responsibility & any liability for infringement of such rules & agree to accept the tournament arbitrator’s decision as final. I consent to allow any reproductions of me or likeness created in any manner whatsoever, photographed, filmed or video taped in connection with NBL/SKIL events which can be used for instruction, publicity, promotion or television broadcast & I waive any & all compensation in regards thereto. I agree that I have obtained permission from the artist(s) of any music I use in conjunction with my competition & verify by signing this permission that in doing such, I will indemnify, defend & hold harmless all the above named parties from any liability for use of such music & that this artist’s permission permits the above named parties to use such music in recorded performances of myself for instructional purposes, publicity, promotion, video &/or televised broadcast & I waive any & all compensation for such.

I also understand that my registration is not complete until payment has been received and verified by Cain's Taekwondo Academy or the staff of SMAC Internationals.

Agree Disagree  

Comments: