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Event Registration Form

LEE H. PARK MEMORIAL CHAMPIONSHIP

                                            CAPE GIRARDEAU, MISSOURI

                                                    November 1st 2008

 

PARTICIPANT’S NAME _______________________________________ AGE ______ RANK____________

 

HOME ADDRESS _____________________________________________ PHONE _____________________

 

                              _____________________________________________

 

                              _____________________________________________

 

HEAD INSTRUCTOR _____________________________________________________ RANK ___________

 

NAME OF SCHOOL ________________________________________________________________________

 

SCHOOL CITY ____________________________________________________________________________

 

 

 

                                                                 COMPETITORS RELEASE

I the undersign, hereby acknowledge that I am aware of and fully appreciate the nature of the Premises, of the American Martial Arts Sports and Education Association Sikeston Winter Championships held at Scott County Central High School Sikeston, Missouri, of the physical activity in which I have requested to be allowed to participate, and of the danger of death or injury by my participation therein, and I knowingly, deliberately, and voluntarily choose to expose myself therto and I assume all risks therin, and I solemnly Covenant, Contract, and agree that, if I am injured thereby, I have released, or I will, without the tender of payment of  any other or further consideration whatosever, release, indemnify, save and hold harmless from liability, whatsoever, any Official Associations, Corporations, Sponsor, Promoter, or anyone involved in said Championships, and Thereby assume full and sole responsibility for death and injury to my person.  I have read the foregoing, or it has been read to me, understand the same, and agree to abide by all rules promulgated and to be promulgated by the American Martial Arts Sports and Education Association Sikeston Winter Championships held at Scott County Central High School Sikeston, Missouri.

 

SIGNED __________________________________________________________DATE________________

                                                           

                                                                                            PARENT OR GUARDIAN RELEASE

For the consideration stated above, I/We parent(s) or legal guardian(s) of the minor stated above consent to and approve his/her Participation in the above named Championships, and agree to indemnify, save and hold said Championships from any loss, cost, liability, expense, or responsibility, whatsoever arising directly or indirectly, out of any injury or death that said minor might sustain as a result of participation in said Championships.

 

SIGNED _________________________________________________________DATE___________________

 

 

Please complete a separate registration for each family member. Registration Costs are $35.for 1, for 2 or more in the same family $25 per person.                      Checks payable to MSKMO.

 

 
 

 

 

 
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