Events - Master Shim's World Class Tae Kwon Do

First Name*

Last Name*

Middle Initial

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Home Phone*

Date of Birth*

Age (At Time of Competition)*

Sex*

Male
Female

Height*

Weight*

Belt Rank*

Tae Kwon Do School*

Master Name*

School Phone*

Choose Standard Events

Spirit (Little Tigers & New White Belts )
Forms
Breaking
Sparring

Does competitor have a history of any of the following?

Epilepsy (Seizures)
Lung Disease
Heart Disease
Diabetes
High Blood Pressure
None of the above

Check only ones that are applicable

Liability Waiver*

In consideration of your acceptance of my entry. I do hereby, for myself, my heirs, executors, and administrators waive, release forever discharge any and all rights and claims for damages, which I may have or may accrue to me against US Yong In Presidential Cup. or its Directors, and/or all persons associated with the event in any capacity, US Yong In Presidential Cup, 2023 Georgia State Organizing Committee, the cities of Hampton or Fayetteville, and all members of the tournament, or their respective officers, agents, representatives, successors, and/or assigns, and against any of my competitors for any and all damages which may be sustained by me in connection with my association or entry in the above athletic meet and competition, and in connection with any medical services provided to me in connection with any such injury or illness, or which may arise out of traveling to, participating in, and returning from this athletic meet. I understand that Tae Kwon Do is a body contact sport, and I further understand all contents of the 2023 rules and regulations and general information which was published by the sponsors and I agree with them in their entirety. I further understand that I may be dismissed from the premises without compensation or refund if my conduct is not courteous and cooperative for the successful operation of the championships. I waive any compensation what so ever for the use of pictures, movies, etc. of me by the promoter.

I hereby agree to all terms and conditions of the liability waiver above.

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Expiration Date (Enter 01 if no DD)*

Security Code*

Billing Zip Code*

10th Yong In University Presidential Cup Registration Form