TOURNAMENT REGISTRATION

Western Canadian Karate Championship – Official Entry Form

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COMPETITOR Name** *

Experience

Rank (Belt Colour) *

COMPETITOR Age *

Style

Email *

Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

CLUB DETAILS

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Club Name *

Instructor *

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Club Address

Phone

WAIVER

I hereby voluntarily submit my application for attendance and participation in the “WESTERN CANADIAN KARATE CHAMPIONSHIPS” as shown on this form, and do hereby assume full responsibility for any and all damages, injuries or losses that I may sustain or incur, if any, while attending or participating, and I hereby waive all claim against the promoters, or operators , or sponsors of said ”WESTERN CANADIAN KARATE CHAMPIONSHIPS” individually or otherwise, for any claim for injuries that I might sustain.

I fully understand that any medical treatment given to me will be of FIRST AID nature only.

I consent that any pictures of me or any picture taken of me in connection with the Championships can be used for publicity, promotion or television showing and I waive compensation in regard thereto.

IF THE APPLICANT IS UNDER 18 YEARS OF AGE, THIS APPLICATION MUST BE SIGNED BY HIS OR HER GUARDIAN OR PARENT.

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Participant Signature *

Date Signed *

Parent or Guardian (If Applicable)

Date Signed

TOURNAMENT FEES

Entrance Fee *

Price: $75.00

1-2 Divisions are included in your $75 payment. Choose 2 below.

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Select DIVISION 1 (included) *

Select DIVISION 2 (included) *

Additional Divisions – select ONLY after choosing 'DIVISION 1' and 'DIVISION 2' above.

Please do not select any additional divisions until you have chosen your main 1 (ONE) – 2 (TWO) divisions above. If you have questions about this, please contact us before registering. All sales are FINAL.

DO NOT check any of the ‘Additional Divisions’ boxes if you are competing in ONLY 2 (TWO) events

Please ENSURE you have read the above sections carefully. DO NOT check any of the ‘Additional Divisions’ boxes if you are competing in ONLY 2 (TWO) events; Select them from the above drop down instead.

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Square Payment *

Credit Card field is disabled, Square account connection is invalid. Please, contact to the site administrator.

Please note: All sales are FINAL. Please ENSURE you have read the above sections and selected your divisions carefully. Online registration closes May 22, 2024.

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$0.00