TRACKIE - Online registration for events, tournaments, clubs and organizations...

Registrant #1

Hide List

Are you a new or renewing member?Karate BC # (if applicable) Lookup

First Name *

Last Name *Is your Name incorrectly spelled?

Gender *

Male Female

Date of Birth (YYYY *-MM-DD)

/ /

No category for this age.

Dojo *

Tournament Experience *

Athlete Phone * - International Number

Athlete Email * Opt in to emails

Parents Name *

Parents Phone * - International Number

Parents Email * Opt in to emails

This registrant is competing in a team kata ONLY.

Division

Division *

Category *

There are no available categories for the age of this registrant.

Add another division

Waivers

Waiver items are required for this registration. If you do not have legal rights to complete waiver items on behalf of the registrant please enter the email address of the registrant or parent/guardian (if the registrant is under the age of majority). ?

I am registering myself or I am the parent/guardian of the registrant or I have legal rights to complete waiver items on behalf of this registrant *

Yes No

Email address to send waiver to *

INDIVIDUAL LIABILITY WAIVER- MANDATORY for All Karate Competitors

All KUMITE competitors are required to submit a medical report. This report shall be in two parts. Part A shall be a medical history questionnaire that each kumite competitor shall complete. Part B shall be a medical examination report to be completed by a licensed physician., and is required of kumite competitors who have significant health problems as related in Part A. If the answers to part A are all 'No', then part B need not be completed.

The medical report must be submitted at tile time of registration for a tournament, to the tournament director, for review by the medical director.

The medical director will determine if a competitor is or is not medically fit to compete in Kumite. Please note that no medical examination report is required of Kata-only competitors.

All competitors should be aware of the following:

No tapes, splints or protective equipment may be worn during kumite matches without the approval of the tournament medical director. Exceptions are approved protectors, e.g., scrotal protectors, fist protectors, and shin pads. A mouth guard is compulsory for kumite competitors.
Approved safety sports glasses will be permitted. Athletes who compete in international competitions may not be per mitted to use safety sports glasses, but may be required to use soft contact lenses pursuant to international rules. Regular eyeglasses are not allowed in Kumite.
If a competitor is injured during a match and is determined to be medically unable to continue that match, he may not compete in another match during the same tournament without first obtaining medical clearance from thetournament medical director.
Disqualification following an injury may result in either the injured competitor or his opponent being declared tile winner. The circumstances under which the injury occurred will be considered by tile referee and judges in deciding who is the winner.
In the interest of safety, all flinger and toenails must be trimmed short.
No personal jewelry may be worn during kumite, including jewelry in man-visible areas.
All competitors are advised to see their regular physician for follow-up medical examination of injuries suffered during the tournament. It should be noted that tile full extent of some injuries may not manifest themselves until some time following1the injury, e.g., abdominal injuries or head injuries. Hence, anyone who has continuing symptoms or who is concerned about an injury should consult his or Iler physician.

Acknowledgment and Release

By his/her signature below, the Tournament Competitor ('Competitor') or Parent/Guardian if under 19, acknowledges that he/she has read the 'Note to Karate Competitors' above, and that the requisite information required in this form has been disclosed. Tile Competitor expressly confirms that he/she has disclosed all illnesses, injuries, ailments, symptoms, or medical conditions of any kind whatsoever suffered or sustained by the Competitor as requested in the Medical Examination Report. It is also understood that the Competitor will consult his/Iler physician for a physical examination should an examination be requested by the Tournament Medical Director.

Furthermore, the Competitor hereby releases Yoshiaki Sato, Vancouver Shitoryu Satokai, Shitoryu Satokai Association of BC and their employees, agents, successors, assigns, directors or volunteers from any and all liabilities arising out of or connected with any loss, damage, injury or expense suffered or sustained by the Tournament Competitor as a consequence of or in connection with his/her participation in the Tournament Competition or any activity related thereto.

Results from this event may be published in media.

I have read and agree to the above *

Instructor Name *

Address *

Dojo Name *

*Privacy Disclosure

Medical and personal information contained within will be available for review by members of the Association's Medical committee and their assistants. In the event of injury, a competitor's information may be shared with health care

providers assisting that athlete. Signing this form gives consent to said use of a competitor's personal information.

I consent to have my image or name, and/or the image or name of my child used in the promotion of this event.

MEDICAL EXAMINATION REPORT

Part A – MANDATORY COMPLETION by all KUMITE competitors

1. Have you any disease of the eyes? *

Yes No

2. Do you have a hearing loss? *

Yes No

3. Do you have fainting spells, blackouts or epilepsy? *

Yes No

4. Have you had a head injury within the past year? *

Yes No

5. Do you have bronchial asthma? List treatment below *

Yes No

6. Do you have any active lung infection including TB? *

Yes No

7. Do you have any heart disease or high blood pressure? *

Yes No

8. Do you have an active kidney disease, infection or failure? *

Yes No

9. Do you have any loss of all or part of a limb? *

Yes No

10. Do you have decreased movement in any limb, joint or spine? *

Yes No

11. Do you have any muscle or joint disease? *

Yes No

12. Do you have diabetes? *

Yes No

13. Do you have hepatitis, AIDS/HIV or any other blood borne disease? *

Yes No

14. Are you taking any medication? *

Yes No

15. Do you have allergies to any medications? *

Yes No

16. Have you had any recent operations, fractures or major illness? *

Yes No

17. Do you have any disease or disability not mentioned above? *

Yes No

If you answered “Yes” to any of the above questions, give details and obtain medical clearance from your physician to compete. (Information provided not confidential)

Waiver agreement

I hereby declare that I have read the above information and that, to the best of my knowledge, it is complete and correct.

I have read and agree to the above *

MEDICAL EXAMINATION REPORT - Part B – to be completed by examining physician if “YES” was answered on any questions in Part A DOWNLOAD HERE

Digital signature (type your name exactly as entered above "registrants name") *

Parent/guardian digital signature *

24th Annual Sato Cup

Please fix the following errors:

Division

Waivers

INDIVIDUAL LIABILITY WAIVER- MANDATORY for All Karate Competitors

Acknowledgment and Release

*Privacy Disclosure

MEDICAL EXAMINATION REPORT

Waiver agreement

Please fix the following errors:

Division

Waivers

INDIVIDUAL LIABILITY WAIVER- MANDATORY for All Karate Competitors

Acknowledgment and Release

*Privacy Disclosure

MEDICAL EXAMINATION REPORT

Waiver agreement

Which Province/Territory?

Which club do you want to join?

Loading, please wait...

Which club do you want to join?

Loading, please wait...

Which club do you want to join?

Loading, please wait...

Which club do you want to join?

Loading, please wait...

Which club do you want to join?

Loading, please wait...

Which club do you want to join?

Loading, please wait...

Which club do you want to join?

Loading, please wait...

Which club do you want to join?

Loading, please wait...

Which club do you want to join?

Loading, please wait...

Which club do you want to join?

Loading, please wait...

Which club do you want to join?

Loading, please wait...

Which club do you want to join?

Loading, please wait...

Which club do you want to join?

Loading, please wait...