REGISTRATION FORM

Name:  ____________________  USTF School:  _____________________

Rank:  ____________________   Age:  _____   Sex:  _____

Address;  ______________________________  City:  _____________ 

State:  __________   Zip: __________  Phone:  __________

Email:  _____________________________________

Only $30.00 for any and all individual events

Patterns:   Yes:_______    No:  ____     Sparring:     Yes:_______    No:  ____

Breaking: Yes:_______    No:  ____

Team Patterns $30.00 per team

Make check payable to Axe Taekwon-Do (AXE TKD)

Mail this page with payment to either:

Master Ricky J. Todd             or                  Mr. Kevin A. Bushor
3355 Rahn Blvd                                             14401 S. 34th Street

2nd Annual Axe Taekwon-Do Invitational
USTF Taekwon-Do Tournament
Liability and Photograph Release
May 9th, 2009

In consideration of my and/or my child’s participation in this event, I hereby, for myself and for and on behalf of my child, indemnify, release, forever discharge and agree to hold harmless the Tournament Promoters, Axe Taekwon-Do, The Offutt Youth Center, The United States Taekwon-Do Federation, Inc. and the officers, employees and agents thereof, from any and all liability, claims or demands for personal injury, sickness, or death, as well as property damage and expenses of any nature whatsoever, including reasonable attorney fees, which may be incurred by the undersigned and/or the child participant while participating in this event.

I clearly understand that the sport of Taekwon-Do involves bodily contact.  I am aware of my, and my child’s personal medical condition and hereby certify that my, and or/my child’s participation is voluntary, and that I and/or my child are mentally and physically fit to participate in this event.

I hereby consent to and authorize the taking of photographs or videotape in which I and/or my child may appear.  I hereby waive for myself and for and on behalf of my child, all rights of privacy in and to any said photographs or videotapes, including without limitation, any and all claims for the libel and/or invasion of privacy.  I hereby grant for myself and for and  on behalf of my child, to Axe Taekwon-Do and the Tournament Promoters the irrevocable right and permission, in respect to the photographs or video tapes that are taken or have been taken of me to use, reuse, publish, re-publish, modify and display the same, in whole or in part, individually or in conjunction with other photographs, and in conjunction with any other copyrighted matter, in any and all media now and hereafter know, for illustration, promotion, art, advertising and trade, or any purpose whatsoever; and to use my name in connection therewith if it so chooses.

Signature: ____________________________      Date: _______________

Parent or Guardian (if under 18) ___________________________________________

My health insurance is through _____________________________________________ and is current.  You MUST provide current information in order to compete.  Green belt competitors and above must present current USTF membership cards at time of check-in.