Pre-Registration Form

RIVER CITY KARATE PRE-REGISTRATION FORM NOTE: PLEASE MAKE SURE YOU MAIL THIS FORM TO BE RECIEVED BEFORE THE DEADLINE DATE OF JULY 5 To get the discounted price of $40. for 3 events
Name:	Age:	Date of Birth:
Address:	City:	State:	Zip:
Karate School:	Instructor:	Rank:
School Address:	City:	State:	Zip:
WAIVER AND RELEASE OF LIABILITY
Upon submitting this application to compete at this tournament, I, with my signiture on this application, do hereby assume complete responsibility for any and all injuries that I may sustain during this competitive event. Therefore, I hereby relieve all liabilities from the promoters and all persons associated with this event. I further agree to allow pictures to be taken of me or by me in connection with the tournament to be used for publicity and/or promotional purposes without compensation now or in the future. I have read this release and understand and agree to all its items.
IF COMPETITOR IS UNDER 18, THIS RELEASE & CONSENT MUST ALSO BE SIGNED BY A PARENT OR GUARDIAN
Signature of Parent or guardian:	Date:
Signature of Competitor:	Date:
Please make money orders payable to: "Chase Russell" and mail to: River City Karate 4505 Hwy. 31 South Decatur, Alabama 35603 Please check the division(s) you will be entering: Weapons (__) -- Forms (__) -- Fighting (__)