BJJ & GRAPPLING REGISTRATION

Name______male [ ] Female [ ] Weight______

Birth Date _____/_____/_____ Age ______E-Mail______(print neatly)

Address______Home Phone ( ) ______

City______State______Zip______Years experience ______

Martial Arts School ______Instructor ______Team______

Is this your first Kumite Classic? [YES] [NO] Did you stay at the Double Tree? [YES] [NO] Did you: [Fly] or [Drive]

Please Circle All That Apply: [Mailing List] [kumiteclassic.com] [flyer/postcard ] [mixedmartialarts.com] [Martial Arts School]

How did you hear about the Kumite Classic? If Referral, Who?______Other______

GI (Jiu-Jitsu) NO GI (Grappling) Cross Over Both BJJ & Grappling

SELECT YOUR AGE CATEGORY: _____ Adult Male (18-29) Broken down by weight TOURNAMENT RELEASE AND WAIVER _____ Executive (30-39) Broken down by weight _____ Masters (40+) Broken down by weight _____ Women Broken down by age and weight _____ Teen (13-17) Broken down by age and weight I, (print name) ______the undersigned, hereby waive all claims against Kumite Classic En- _____ Youth (12-) Broken down by age and weight tertainment Corp., William Viola III, The Western Pennsylvania Police Athletic League Kumite International, The Monroeville Convention NO GI (GRAPPLING) EXPERIENCE: Saturday May 25th Center, and any and all other persons associated with this event in any _____ Novice: under 1 Year training (no wrestling experience) capacity from any and all liability due to injuries that I may incur as a _____ Intermediate: 1-3 years training result of my attendance and/or participation at this event. I understand _____ Advanced: More than 3 Years training the rules of the tournament and will abide by them. I understand that I am participating in a sport that has body contact. I assume full respon- GI (JIU-JITSU) EXPERIENCE: Saturday May 25th sibility for all of my actions during and connected to the above tourna- _____ WHITE ment. I understand the risk of competing in this form of Martial Arts _____ BLUE competition and hereby release the event organizers and all of its em- _____ PURPLE / BROWN / BLACK ployees and associates, tournament sponsors, and the event facility, from any type of injury, loss, or death sustained while competing in this Early Pre-Register: Before April 11th (get +free t-shirt) competition. I also state that I am in good mental and physical condition and know of no reason why I cannot participate in this Martial Arts One Event $55.00 (one event) event. I have current and valid health insurance. Divisions or weight Crossover +$15.00 (both Gi & No-Gi) classes are subject to change. In case of an emergency, I hereby au- thorize any licensed medical personnel to perform any accepted medi- Pre-Register: Before May 11th (post mark) cal procedure deemed necessary and I agree to bear the expense of One Event $60.00 (one event) any such treatment. I understand that a valid birth certificate may be Crossover +$20.00 (both Gi & No-Gi) required to compete at this event. I also agree that my attendance and/ or performance at the tournament may be photographed, filmed, or Registration: After May 11th or @ The Door (May 26th) taped and used by any schools and I waive any compensation thereof. One Event $75.00 (one event) I have read, understand and agree to abide by the rules associated Crossover +$25.00 (both Gi & No-Gi) with this event and assume all responsibility and any associated liability for infringement of such rules and sign below to complete this form:

ALL postal mail must be post marked by May 11th After May 13th please signup @ the door. Pre-Register Money Order Payable To: ______“Kumite Classic” Competitors Signature Date 12421 St. Nikolai Dr. North Huntingdon, PA 15642

Always keep a copy of your money order receipt. We are not responsible for lost registration materials. If you wish to (cross over) and enter both Gi & No-Gi you must register for both at the $ same time to take advantage of discounted rates. *We reserve ______the right to expand, create, or combine divisions to accommodate Signature of parent / guardian who assumes competitors or special circumstances. Information subject to change at the discretion of the coordinator and head referee. Sorry no refunds for any reason. complete responsibility (if under the age of 18) Pre-register at your own risk. There are no substitutions or refunds for missing your divisions.

Saturday May 25th 2103 - Monroeville Convention Center - Download Full Flyer www.kumiteclassic.com LIABILITY RELEASE, WAIVER, DISCHARGE AND COVENANT NOT TO SUE This is a legally binding liability release, waiver, discharge and covenant not to sue (the “Release”), made by me, the undersigned, to Kumite Classic Entertainment Corp.

I, (PRINT NAME CLEARLY) ______,

Fully recognize that there are dangers and risks to which I may be exposed by participating in the Kumite Classic Jiu-Jitsu and Grappling tournament, which involves strenuous physical activity and ex- tensive physical contact with other people and a mat, including but not limited to joint locks, throws, chokes, strikes, ground wrestling, and other similar activity. I understand and acknowledge that grap- pling and jiu-jitsu activities in general have inherent dangers that no amount of care, caution, training, instruction, supervision or expertise can eliminate. With full understanding of the risks involved and de- spite this Release, I am voluntarily entering the Kumite Classic. I therefore agree to assume and take upon myself all of the risks and responsibilities in any way associated with this activity. I release Kumite Classic Entertainment Corp., its agents, volunteers, and William Viola III from any and all liability, claims and actions that may arise from injury or harm to me, from my death or from damage to my property in connection with this tournament. I acknowledge and fully understand that I will be engaging in activities that involve risk of serious injury, and that severe social and economic losses may result not only from my own action, inactions or negligence, but also from the actions, inactions or negligence of other not- withstanding the rules of play or the condition of the premises or of any equipment used. Further I ac- knowledge and fully understand that there may be other associated risks with such activities that are not known or not reasonably foreseeable at this time. I understand that this Release covers liability, claims and actions caused entirely or in part by any acts or failures to act by Kumite Classic Entertainment Corp., its agents, volunteers, including but not limited to negligence, mistake, or failure to supervise. I recognize that this Release means I am giving up, among other things, rights to sue Kumite Classic En- tertainment Corp., its agents, and volunteers for injuries, damages, or losses I may incur while participat- ing in this tournament. I also understand that this release binds my heirs, executors, administrators, and assigns, as well as myself.

I EXPRESSLY AND VOLUNTARILY ASSUMES ALL RISK OF PERSONAL INJURY, PERMANENT, TEMPORARY, TOTAL OR PARTIAL DISABILITY, DISFIGUREMENT, PARALYSIS AND ANY OTHER LOSSES OR DAMAGES TO PERSON OR PROPERTY OR DEATH, SUSTAINED WHILE PARTICI- PATING IN THE KUMITE CLASSIC, INCLUDING THE RISK OF PASSIVE OR ACTIVE NEGLIGENCE OF THE RELEASEES, OR HIDDEN, LATENT, OR OBVIOUS DEFECTS IN THE FACILITIES OR EQUIPMENT USED.

I HEREBY FOREVER RELEASE, DISCHARGE AND COVENANT NOT TO SUE KUMITE CLASSIC ENTERTAINEMNT CORP. I ACKNOWLEDGE THAT I HAVE HAD SUFFICIENT OPPORTUNITY TO REVIEW THE PROVISIONS OF THIS DOCUMENT AND UNDERSTAND ITS PURPOSE, MEANING AND INTENT. I HAVE READ THE ENTIRE RELEASE, I FULLY UNDERSTAND IT, AND I AGREE TO BE LEGALLY BOUND BY IT.

THIS IS A RELEASE OF YOUR RIGHTS. READ CAREFULLY BEFORE SIGNING.

______Releaser’s Signature Date

______Parent’s or Guardian’s Signature, if a minor (under 18) Witness IMPORTANT INFORMATION

Event: 14th Annual Kumite Classic Promoter: Kumite Classic Entertainment Corp Director: Bill Viola Telephone: 724-861-5162 Monroeville Convention Center E-Mail [email protected] Website www.kumiteclassic.com Venue: Monroeville Convention Center Date: Memorial Day Weekend 209 Mall Boulevard Friday May 24th: Early Weigh-ins Monroeville, PA 15146 Saturday May 25th GI BJJ Divisions Free Parking Saturday May 25th NO GI Grappling Hotel: Double Tree Monroeville *competitors can weigh-in early Friday night or Saturday morning. 412-373-7300 101 Mall Boulevard Monroeville, PA 15146 Adjacent to convention center

*Double Tree will sell out quickly, book in advance! Must mention “KUMITE CLASSIC” Room Block  Kumite Discount rooms: $124.00  Reservation Deadline May 12th

AIRPORT: Pittsburgh International (PIT)

Overflow Hotel: Holiday Inn: 412-372-1022 Kumite Discount Rooms: $124.00

SPECTATOR FEES: General Admission Friday $10.00 FRIDAY MAY 24th General Admission Saturday $15.00 *Competitors receive free expo admission all weekend  Registration & Early Weigh-ins 2pm-6pm  Consumer Expo 4pm-9pm IMPORTANT INFORMATION  You may register at the door  All postal Pre-Registrations or Registrations: SATURDAY MAY 25th Must be post marked by May 11th. Please do not mail any forms after this date, instead BJJ Brazilian Jiu-Jitsu & NO GI GRAPPLING please register the day of the tournament.  Registration & Weigh-ins 7:00 AM-9:00 AM  No sandbagging. If you have previous wrestling  Orientation on the Mat 9:00 AM experience, you are not permitted to compete in the  BJJ Competition 9:15 AM novice divisions.  NO GI Grappling immediately to follow  No refunds, please don’t ask.  No substitutions, please don’t ask. FREE T-SHIRT EARLY  Pre-registered competitors can pick up credentials PRE-REGISTERED COMPETITORS Early weigh-ins Friday between 2:00pm-6:00pm or the day of your event starting at 7:00am Sat.  We accept registrations at the door if you miss the pre-reg deadline.  If you want to (cross over) and enter both Gi & No-Gi competition, you must register them both at the same time, no exceptions.

 Competitor entries include free general admission to

the Kumite Classic for the entire weekend. Pick up your credentials on Friday and enjoy the expo at no charge with your competitor band  We reserve the right to combine or create divisions FREE shirt to accommodate competitors. Changes are made at T- w/PRE the discretion of the coordinator. Registration  Updated info always visit www.kumiteclassic.com

BJJ & GRAPPLING DIVISIONS

Please check all divisions you wish to enter: -SATURDAY: BEGINS WITH BJJ DIVISIONS NO-GI GRAPPLING TO FOLLOW

Type # Age Rank Weight Division (M/F) Day BJJ- 1 12- belts & weight separated at ring all weights Youth Male/Female Saturday BJJ- 2 13-17 belts & weight separated at ring all weights Teen Male Saturday BJJ- 3 13-17 belts & weight separated at ring all weights Teen Female Saturday BJJ- 4 18+ all belts separated at ring 134.9- Women's Light Female Saturday BJJ- 5 18+ all belts separated at ring 135+ Women's Middle Female Saturday BJJ- 6 18-29 White Belt 144.9- Men's Feather Male Saturday BJJ- 7 18-29 Blue Belt 144.9- Men's Feather Male Saturday BJJ- 8 18-29 Purple/Brown/Black Belt 144.9- Men's Feather Male Saturday BJJ- 9 18-29 White Belt 145-159.9 Men's Light Male Saturday BJJ- 10 18-29 Blue Belt 145-159.9 Men's Light Male Saturday BJJ- 11 18-29 Purple/Brown/Black Belt 145-159.9 Men's Light Male Saturday BJJ- 12 18-29 White Belt 160-174.9 Men's Middle Male Saturday BJJ- 13 18-29 Blue Belt 160-174.9 Men's Middle Male Saturday BJJ- 14 18-29 Purple/Brown/Black Belt 160-174.9 Men's Middle Male Saturday BJJ- 15 18-29 White Belt 175-189.9 Men's Light Heavy Male Saturday BJJ- 16 18-29 Blue Belt 175-189.9 Men's Light Heavy Male Saturday BJJ- 17 18-29 Purple/Brown/Black Belt 175-189.9 Men's Light Heavy Male Saturday BJJ- 18 18-29 White Belt 190-209.9 Men's Heavy Male Saturday BJJ- 19 18-29 Blue Belt 190-209.9 Men's Heavy Male Saturday BJJ- 20 18-29 Purple/Brown/Black Belt 190-209.9 Men's Heavy Male Saturday BJJ- 21 18-29 White Belt 210+ Men's Super Heavy Male Saturday BJJ- 22 18-29 Blue Belt 210+ Men's Super Heavy Male Saturday BJJ- 23 18-29 Purple/Brown/Black Belt 210+ Men's Super Heavy Male Saturday BJJ- 24 30-39 all belts separated at ring 174.9- Executive Light Male Saturday BJJ- 25 30-39 all belts separated at ring 175-199.9 Executive Heavy Male Saturday BJJ- 26 30-39 all belts separated at ring 200+ Executive Super Heavy Male Saturday BJJ- 27 40+ all belts separated at ring 174.9- Masters Light Male Saturday BJJ- 28 40+ all belts separated at ring 175-199.9 Masters Heavy Male Saturday BJJ- 29 40+ all belts separated at ring 200+ Masters Super Heavy Male Saturday Type # Age Rank Weight Division (M/F) Day G- 1 12- rank & weight separated at ring all weights Youth Male/Female Saturday G- 2 13-17 rank & weight separated at ring all weights Teen Male Saturday G- 3 13-17 rank & weight separated at ring all weights Teen Female Saturday G- 4 18+ all ranks separated at ring 134.9- Women's Light Female Saturday G- 5 18+ all ranks separated at ring 135+ Women's Middle Female Saturday G- 6 18-29 Novice 144.9- Men's Feather Male Saturday G- 7 18-29 Intermediate 144.9- Men's Feather Male Saturday G- 8 18-29 Advanced 144.9- Men's Feather Male Saturday G- 9 18-29 Novice 145-159.9 Men's Light Male Saturday G- 10 18-29 Intermediate 145-159.9 Men's Light Male Saturday G- 11 18-29 Advanced 145-159.9 Men's Light Male Saturday G- 12 18-29 Novice 160-174.9 Men's Middle Male Saturday G- 13 18-29 Intermediate 160-174.9 Men's Middle Male Saturday G- 14 18-29 Advanced 160-174.9 Men's Middle Male Saturday G- 15 18-29 Novice 175-189.9 Men's Light Heavy Male Saturday G- 16 18-29 Intermediate 175-189.9 Men's Light Heavy Male Saturday G- 17 18-29 Advanced 175-189.9 Men's Light Heavy Male Saturday G- 18 18-29 Novice 190-209.9 Men's Heavy Male Saturday G- 19 18-29 Intermediate 190-209.9 Men's Heavy Male Saturday G- 20 18-29 Advanced 190-209.9 Men's Heavy Male Saturday G- 21 18-29 Novice 210+ Men's Super Heavy Male Saturday G- 22 18-29 Intermediate 210+ Men's Super Heavy Male Saturday G- 23 18-29 Advanced 210+ Men's Super Heavy Male Saturday G- 24 30-39 all ranks separated at ring 174.9- Executive Light Male Saturday G- 25 30-39 all ranks separated at ring 175-199.9 Executive Heavy Male Saturday G- 26 30-39 all ranks separated at ring 200+ Executive Super Heavy Male Saturday G- 27 40+ all ranks separated at ring 174.9- Masters Light Male Saturday G- 28 40+ all ranks separated at ring 175-199.9 Masters Heavy Male Saturday G- 29 40+ all ranks separated at ring 200+ Masters Super Heavy Male Saturday

Information subject to change. We reserve the right to create or combine divisions to accommodate competitors. These divisions are an outline, and are subject to change at the discretion of the coordinator. *Absolute Advanced division must have a minimum of at least 4 competitors to award any prize money. There are “NO REFUNDS” Please don’t ask. Pre-register at your own risk. GI RULES SUMMARY

GI DIVISIONS ARE AWARED POINTS FOR: FOR ALL WHITE BELTS, CHILD & TEEN COMPETITORS: · TAKEDOWNS 2PTS. NO ATTACKS BELOW THE WAIST · SWEEP FROM THE GUARD 2PTS. (KNEE BARS, HEEL HOOKS, FOOTS LOCKS ETC.) BLUE BELTS, MASTERS, SENIORS, WOMENS: · KNEE ON BELLY 2PTS. ANKLE LOCKS PERMISSABLE · PASS GUARD TO SLIDE 3PTS TWISTING ANKLE AND LEG LOCKS ARE NOT ALLOWABLE · REAR MOUNT 4PTS ADULT MENS PURPLE BELT AND ABOVE: · MOUNT 4PTS STRAIGHT ANKLE LOCKS AND KNEE BARS ARE ALLOWED YOU MUST HOLD THE POSITION FOR 3 SECONDS TOE HOLDS ARE ALLOWED, (AKA FIGURE FOUR)

NO-GI RULES SUMMARY

· CONSCIOUSLY SUBMITTING, IT IS VERY IMPORTANT THAT ALL COMPETITIORS UNDERSTAND HOW TO “TAP-OUT” WHEN CAUGHT IN A SUBMISSION TECHNIQUE. TAPPING OUT CAN BE DONE PHYSICALLY OR VERBALLY · DIVISIONS UNDER AGE 12, 3 MINUTES/ ALL OTHER DIVISIONS 4 MINUTES IN LENGTH. EXCEPT FOR ADULT INTERMEDIATE 5 MINUTES, & ADVANCED ADULT WHICH ARE 6 MINUTES · ILLEGAL SUBMISSION TECHNIQUES: *No attacks to, eyes (elbows, palms, fingers, etc) No fish hooks, not hair pulling or biting. No pushing palm or elbow directly into nose and no excessive cross facing · NO STRIKING OF ANY KIND THIS INCLUDES, HEADBUTTS PUNCHES, ELBOWS, KNEES, KICKS ETC. · NO DROPPING OR SLAMMING OPPONENT ON THEIR HEAD, NO SLAMMING FROM THE GUARD POSITION · FIGHTERS ARE NOT ALLOWED TO GRAB OR USE THEIR OPPONENTS CLOTHING. T-SHIRTS ARE OPTIONAL IN THE NO- DIVISIONS · IF A MATCH IS CONSIDERED A DRAW (BY THE REFEREE) , THEN THERE WILL BE A 2 MINUTE OVERTIME. JUDGES ARE EN- COURAGED TO CHOOSE A WINNER IN EVERY MATCH SHOULD IT NOT END BY A SUBMISSION. · IF A MATCH IS DEADLOCKED, THE REFEREE MAY RE-START THE MATCH FROM A STANDING POSITION. · NO-GI DIVISIONS, UNIFORM ARE NOT REQIIRED, AT A MINIMUM SHORTS WITH A DRAW STRING, A CUP AND A MOUTH PIECE MUST BE WORN. · NO HEEL HOOKS OR NECK CRANKS ALLOWED IN ANY DIVISION, NO SLAMMING FROM THE GUARD ALLOWED IN ANY OF THE DIVISIONS.

ANY USE OF AN ILLEGAL TECHNIQUE, ANY ACT OF POOR SPORTSMANSHIP, ANY ACT OF DISRESPECT TO THE REFEREES, TOURNA- MENT OFFICIALS OR EMPLOYEES, WILL RESULT IN IMMEDIATE EJECTION FROM THE COMPETITION AND OR PREMISES WITHOUT A REFUND. *THIS APPLIES TO ALL DIVISIONS SPECTATORS AND COACHES.

IMPORTANT INFORMATION

DIVISIONS ARE SUBJECT TO CHANGE DEPENDING ON THE SIZE OF THE EVENT, PARTICIPATION AND OTHER ISSUES DEEMED NECES- SARY BY TOURNAMENT OFFICIALS. WE RESERVE THE RIGHT TO REQUEST A DRIVERS LICENSE, BIRTH CERTIFICATE OR OTHER FORMS OF I.D. AT THE TIME ENTRANCE. IF YOU MISS YOUR DIVISION THERE IS NO REFUND! NAMES WILL BE CALLED 3 TIMES FOR A TOTAL OF TWO MINUTES, PLEASE BE AWARE. IN ALL DIVISIONS WE WILL MAKE THE EFFORT NOT TO MATCH PLAYERS FROM THE SAME SCHOOL, UNLESS IT IS UNAVOIDABLE, ESPECIALLY IN THE NO-GI DIVISIONS. ALL ERRORS MUST BE CORRECTED BEFORE THE MATCH BEGINS, NO EXCEPTIONS. REFEREES HAVE THE RIGHT TO CALL A MATCH FOR ANY REASON HE/SHE SEES FIT, SUCH AS UNSPORTSMAN LIKE CONDUCT, UNSAFE TECHNIQUES, DISRESPECT TO THE OFFICIALS ETC., THIS APPLIES TO COMPETITORS, SPECTATORS AND PAR- ENTS NO ONE WILL BE ALLOWED TO ENTER OR PARTICIPATE IF HE/SHE IS SUSPECTED TO BE UNDER THE INFLUENCE OF DRUGS OR ALCOHOL. GENERAL CLEANLINESS EXPECTED, ARRIVE WITH CLEAN ATTIRE AND NO OFFENSIVE ODORS. NO ONE WITH INFECTIOUS DISEASED PERMITTED TO COMPETED, INCLUDING BUT NOT LIMITED TO RINGWORM, STAPH, HERPES ETC. HE PROMOTER AND OFFICIALS HAVE THE RIGHT TO REFUSE ANY ENTRY TO THIS EVENT. PLEASE BE DILIGENT WHEN FILLING OUT YOUR REGISTRATION FORMS, MOST CONFUSION DURING TOURNAMENTS BEGIN WITH AN IMPROPERLY COMPLETED FORM. BE SURE TO INCLUDE ALL REQUESTED INFO AND PRINT LEGIBLY. *WE RESERVE THE RIGHT TO CHANGE OR UPDATE ANY OF THIS INFORMATION. ALL RULES ARE SUBJECT TO THE DISCREATION OF THE COORDINATOR. PLEASE ATTEND THE RULES ORIENTATION AT THE BEGINNING OF THE TOURNAMENT (Based on PBJJF Rules).

MARTIAL ARTS IS BASED ON RESPECT: ALL MATCHES SHOULD BEGIN AND END WITH A HANDSHAKE, PROMOTING THE SPIRIT OF GOOD SPORTSMANSHIP!