REPUBLIC CUP 2019 ALL INDIA KARATE CHAMPIONSHIP 2019 From 11th to 13th January 2019 at Patliputra Sports Complex, Kankarbagh, Patna, Bihar 800020 ORGANISED BY: BHARAT KARATE ACADEMY & INSTITUTE OF MARTIAL ARTS APPROVED BY: KARATE ASSOCIATION OF INDIA – KAI INDEMNITY/CONSENT FORM PASTE RECENT Name: __________________________________________________________________ PASSPORT SIZE COLOR PICTURE Gender: _________Date of Birth: ______________Weight___________Height_______ Address: _______________________________________________________________________________ _________________________________________________________Phone _________________________ School/Club/Association Name: ________________________________________Belt: _______________ Declaration: I, _______________________________________________the undersigned, Parent /legal guardian of _______________________________________________am aware that in the Karate sport, the occurrence of injuries cannot be ruled out. I am also aware that the term “injuries” includes injuries of every description including temporary disablement, permanent disablement as also loss of life. I state that my ward is participating in the above Championship at my risK and responsibility as to the cost and consequences and that we have read and understood the aforesaid and we have signed this Consent Form of our own free will. (If under 18, this release form must be signed by the parents or guardian) _________________________ _________________________ _______________________ Name & Signature of applicant Name & Signature of Instructor Name & Signature of parents EVENT CATEGORY AGE KATA KUMITE REPUBLIC CUP 2019 ALL INDIA KARATE CHAMPIONSHIP 2019 From 11th to 13th January 2019 at Patliputra Sports Complex, Kankarbagh, Patna, Bihar 800020 ORGANISED BY: BHARAT KARATE ACADEMY & INSTITUTE OF MARTIAL ARTS APPROVED BY: KARATE ASSOCIATION OF INDIA – KAI INDEMNITY/CONSENT FORM PASTE RECENT We the undersigned submit our application to participate at The REPUBLIC CUP All India Karate PASSPORT SIZE Championship 2019 from 11th to 13th January 2019 at Patliputra Sports Complex, Kankarbagh, Patna, Bihar COLOR PICTURE 800020, Tournament Organised by Bharat Karate Academy & Institute of Martial Arts and Tournament Approved by Karate Association of India – KAI And do hereby specifically, irrevocably and unconditionally acknowledge and record that we will not have any claim of whatsoever nature arising out of whatsoever cause against the organisers or any persons of the event. The aforesaid will include inter alia all or any claims for damages, loss, death, injury, disability, cost and expenses arising out of our attendance and or participation for whatsoever cause at the event. Without detracting from what is contained above, we hereby specifically, irrevocably and unconditionally waive and abandon all claims of whatever nature arising out of whatsoever cause which we might have against the Bharat Karate Academy & Institute of Martial Arts, The REPUBLIC CUP All India Karate Championship 2019 organisers or any person at The REPUBLIC CUP All India Karate Championship 2019 from 11th to 13th January 2019 at Patliputra Sports Complex, Kankarbagh, Patna, Bihar. The aforesaid indemnity and waiver of liability will extend to any director, shareholders, members employee, instructor, associate, club members or the like who is any way associated to or connected with the THE REPUBLIC CUP All India Karate Championship 2019 Tournament and Organising Committee. We have read, understands and agree to abide by the requirements associated with this event and assume all responsibility and any associated liability for infringement thereof. Additionally, we are fully aware of our personal medical condition and hereby certify that we are mentally and physically fit to participate in The REPUBLIC CUP All India Karate Championship 2019 from 11th to 13th January 2019 at Patliputra Sports Complex, Kankarbagh, Patna, Bihar. I consent to allow any reproductions of me or likeness created in any manner whatsoever, photograph, filmed or videotaped in connection with The REPUBLIC CUP All India Karate Championship 2019 from 11th to 13th January 2019 at Patliputra Sports Complex, Kankarbagh, Patna, Bihar, which can be used for instruction, publicity, promotion or television broadcast and I waive any and all compensation for such. __________________________ _________________________ ____________________________ Name & Signature of Competitor Name & Signature of Instructor Name & Signature of Witness I, the undersigned, being the parent/guardian of the above competitor who is still a minor (i.e. under the age of 18 years), hereby consent to all the condition stated above and signed for by my child. _________________________________________ __________________________________ Name & Signature of Parents/ Guardian ID (Competitor or Parents/Guardian) Name: ___________________________________________Sex: ______Date of Birth: ______________Weight______Height______ Address: ___________________________________________________________________________________________________ ______________________________________________________________________Phone _______________________________ School/Club/Association: ________________________________Belt: _________Coach Name_______________________________ EVENTS: ___________________________________________________________________________________________________ REPUBLIC CUP 2019 ALL INDIA KARATE CHAMPIONSHIP 2019 From 11th to 13th January 2019 at Patliputra Sports Complex, Kankarbagh, Patna, Bihar 800020 ORGANISED BY: BHARAT KARATE ACADEMY & INSTITUTE OF MARTIAL ARTS APPROVED BY: KARATE ASSOCIATION OF INDIA – KAI TEAM ENTRY FORM S. NAME SEX WEIGHT DATE OF BIRTH EVENT FEES NO 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. School/Club/Association Name: ____________________________________________________________ Coach Name: _______________________________________________Phone _______________________ .