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LEE H. PARK MEMORIAL
CHAMPIONSHIP
CAPE GIRARDEAU,
MISSOURI
November 1st
2008
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PARTICIPANT’S NAME
_______________________________________ AGE ______
RANK____________
HOME ADDRESS
_____________________________________________ PHONE
_____________________
_____________________________________________
_____________________________________________
HEAD INSTRUCTOR
_____________________________________________________
RANK ___________
NAME OF SCHOOL
________________________________________________________________________
SCHOOL CITY
____________________________________________________________________________
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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___________________
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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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