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Fee Paid:

Sensei Sign:

Sensei Name:

AGE GROUPS Kata Kumite

Up to 7 yr Incl. Male & Female

8 to 9 yr Incl. Male & Female

10 to 11 yr Incl. Male

10 to 11 yr Incl. Female12 to 13 yr Incl. Male

12 to 13 yr Incl. Female





Jnr Open Black Belt Male (14 17 yrs)*

Jnr Open Black Belt Female (14 17 yrs)*

18 to 34 yr Incl. Male (up to 1st kyu)

18 to 34 yr Incl. Female (up to 1st kyu)

Open Black Belt Male (18 yrs+)**

Open Black Belt Female (18 yrs+)**





55 yr + Male

55 yr + Female

Instructors Male

Instructors Female

GRADE DIVISION

8th

to 7th

Kyu

6t, 5

t& 4

tKyu

3r

Kyu & Above

TEAM EVENTS

Junior Team Kata 8 4t

Kyu (under 18 yrs)

Junior Team Kata 3r

Kyu+ (under 18 yrs)

Team Kata Male (18+ yrs)

Team Kata Female (18+ yrs)

Male Team Kumite (18+ yrs)

Female Team Kumite (18+ yrs)

TEAM NAMES

Kata Team Kumite Team

1 1

2 2

3 3

4

5

NOTE: * 14 - 17 yrs Black Belts MUST enter Junior Open Division.

** 18 - 34 yrs Black Belts MUST enter Open Division.

** Both red & blue GKR /WKF mitts are required for Open division competitors

ENTRY FEES: 12.00 FIRST EVENT, 6 EACH SUBSEQUENT EVENT

Protective equipment is compulsory for Kumite

Note: GKR/IGKF or WKF certified RED or BLUE mitts are now COMPULSORY

for age groups 12/13 yrs & up. Either colour is acceptable except Opens div.> Shin protectors & Mouth Guards must be worn by all competitors.

> Groin guards for all male competitors is compulsory.

> Chest protectors are compulsory for all female competitors from 12 years.GKR KARATE INTERNATIONAL TOURNAMENT DECLARATION

1. I am aware that participation in martial arts, including non-contact GKR tournaments, as with most sports contains a risk of injury.2. In consideration of my acceptance in the competition, I agree that GKR Karate, its servants and agents and all persons involved in the

organisation of the tournament shall be excluded from liability for loss and damage to the fullest extent permitted by law. I accept that thisincludes exclusion of liability for negligence (other than for death or personal injury) and all indirect or consequential loss or loss of profitsarising from participation in the tournament

Signature: Parents Signature:(If under 18 years of age)

Central Zone Regional TournamentSunday, March 4

th, 2012

Cocks Moors Woods Leisure Centre. Alcester Rd Sth, Birmingham B14 6ERPlease complete both pages of this form in full and pass it in to your local instructor along with the entry fee. Thank you!

ENTRY FORM

Name: Age at time of completion:

Address:

Region: Phone:

Dojo: Karate Grade:

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Name: D.O.B:

Address:

Post Code:

Phone Number: Other Number:

Please circle YES or NO to the following questions and statements.

Do you have any allergies? e.g. aspirin; antibiotics; foods? YES NOHave you been in contact with any contagious diseases in the last 3 months? YES NOAre you taking any form of medication at present? YES NOIf the answer is YES to any of these questions, please give details:

Doctors Details:

Name: Phone Number:

Address:

Emergency Contact Details:

Please give two contact numbers where someone can be contacted in the event of an emergency

1. Name: Relationship:


2. Name: Relationship:


Declaration(Delete as applicable)I / My son / daughter is capable of taking part in the GKR Karate Tournament. I am willing to allow my son /daughter to participate in the above activity and confirm that they will be attending the tournament with / withouta parent / guardian / a nominated person who has agreed to supervise my child. In the event of illness or injury,I agree to authorise members of staff attending / participating in the event to consent on my behalf for ananaesthetic to be administered or any other urgent medical treatment to be given on the advice of a qualifiedmedical practitioner / qualified first-aid officer.

Signed: Date:

Name (please print):

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GKR KARATE INTERNATIONALREGIONAL TOURNAMENT

Sunday, March 4, 2012

Cocks Moors woods Leisure CentreAlcester Rd South, Birmingham

8.00am: Competitor Check In

9.30am: Tournament Commences

Competitor Entry Fees: 12.00 first event, 6.00 each subsequent eventSpectators: Adult 5, Child 3, Family 12 (children under 5 years free)

Closing date for entries: Sunday, February 26, 2012(5 late fee will apply)

NO ENTRIES WILL BE ACCEPTED ON THE DAYAll fees are strictly non refundable

Competitors Safety EquipmentNote: GKR/IGKF or WKF certified RED or BLUE mitts are now COMPULSORY for age groups

12/13 years & above. Either colour is acceptable, except in Open divisions where competitors

will require both colours.

Mouth guards and standard white shin protectors, are compulsory.Chest protectors are compulsory for all female competitors 12 years+.Groin Protectors are compulsory for all male competitors.

NB: 1. Competitor to keep this page for tournament details.2. Competitor must hand in entry form along with fees

to instructor.

Documents

CZ 4-3-12