Shinn's
TaeKwonDo
Great Lakes Cup Invitational TaeKwonDo Championship
Online Registration
(payment by credit card only - must be sent by May 29h midnight, 2008 to be processed,
after May 25th, 2008 (and before midnight May 29th), extra $10 fee included)
First Name
*required
Last Name
*required
Number of Tournament
Experiences
*required
Gender (Male/Female)
*required
Street Address
*required
City
*required
Zipcode
*required
Phone
*required
Age (on 5-31-2008)
*required
Height
*required
Email
*required
Weight
*required
TKD School Name
*required
Rank (Gup/Dan)
*required
Belt Color
*required
Novice ( 7th - 10th gup)
white, yellow, orange, green
lntermediate (4th - 6th gup)
green and blue
Advanced (1st- 3rd gup)
brown and red

Black Belt
black

One Event: $60
Two Events $70
Three Events $8
0

Sparring
Forms
Breaking
T-Shirts: To order GLC T-Shirts for $10 ($15 at Tournament), complete the boxes and enclose payment:
Choose shirt size: Child M(10-12) Child L (14-16) Adult: S M L XL XXL ($2 extra for XXL)

Size: Quantity: Fee enclosed for T-Shirts: $

Events Fee $ and T-Shirt Fee $

TOTAL FEE: $

Comments or Special Requests:

LIABILITY WAIVER

In consideration of being allowed to participate in any way in the Great Lakes Cup athletic program or related events, the undersigned acknowledges, appreciates and agrees that, for myself and on behalf of my heirs, assignees, personal representative and the next of kin, hereby release and hold harmless the Great Lakes Cup, Shinn's Taekwondo Academy, Inc., their officials, officers, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event ('Releases") with respect to any and all injury, disability, death, or loss or damage to person or property, whether arising from negligence of the releasees or otherwise.

The risk of injury from the activities involved in this program is significant, including the potential of permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist: and I knowingly and freely assume all such risks, both known and unknown, even if arising from negligence of the releasees or others, and assume full responsibility for my participation.

I willingly agree to comply with the stated and customary terms and conditions of participation. If however I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately

This is to certify that I (or parent/guardian with legal responsibilities for this participant) HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. I do consent and agree to release as provided above of all RELEASEES, and for myself, my heirs, assigns, and next of kin, I release and agree to indemnify the RELEASEES from any and all liabilities provided above, even if arising from their negligence.

Competitor/ Legal Gaurdian - I Agree

Emergency Phone Number

Credit Card
Mast, Visa, AmExp

Security Code *
* last 3 numbers after card num. on back of Visa/Mast - 4 digits on front of Am Exp, above card num.

Number
Name on Card
Expir. Date(mm/dd/yy)

By clicking submit below, I agree to have the fees listed above
charged to the credit card I have given:

Shinn's TaeKwonDo:

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