MPKA Tournament Registration Form

Online Registration Form

Either fill In and press send, or print and bring with you to the Tournament.

Your First Name:***

Your Last Name:***

Your Martial Arts School:***

Martial Arts Style:

Belt / Rank:***

e-Mail Address:
Your Sensei's Name:***
Your Home Address:***

Street:

City:     

State:     Zip Code:

Home Phone:

 

Have you previously participated in a MPKA Tournament?          Yes No

What event will you participate in?

    Empty Hand Kata:            Yes No

    Weapons Kata:                YesNo

    Kumite (Point Sparring): Yes No

Your Participation Fee and Signature will be collected at the event.

     I, the undersigned, knowingly and without duress, do hereby voluntarily submit my application and entry for attendance and participation in this Maryland Professional Karate Association, Inc. (MPKA) tournament. I do hereby  assume all risk of personal physical and mental disabilities, injuries or losses, which may result from or in connection from my participation in this tournament. Acting for myself, heirs, personal representatives, and assignees, I do hereby release the MPKA, its officers, agents, representatives, servants, employees, volunteers, the sponsor location, and all related members from all claims, suits, actions, controversies, claims at law or in equity by reason in any matter, cause or thing whatsoever, that I may sustain as a result of or in connection with my participation in this MPKA tournament.

     I also understand that participation in this MPKA tournament, especially but not limited to fighting, point or contact sparring, matches, breaking, weapons, kata or grappling, entails a great risk of injury, and I assume full responsibility for all of my actions, intentional or otherwise, during and in connection with my participation in this MPKA tournament.

     I fully understand that any medical attention or treatment afforded to me by any of the aforementioned will be of the first aid type only and I fully submit my release. I agree that my performances, attendance, and participation at this MPKA tournament may be filmed or otherwise recorded or telecast live. I consent, by MPKA, its assignees and licensees of my name, likeness voice, poses, pictures and biographical data concerning fully or in parts, in any form or language, with or without material, throughout the world, without limitations, for television, radio, video and/or theatrical motion pictures, or other medium devices now known, or hereafter devised, and I do hereby waive any compensation in regard thereof as well as my future rights to the aforementioned.

By selecting the "Yes" button at the end of this passage I certify that I have read, fully understand, and agree to the waiver listed above. 

Do Not Check "Yes" unless you are 18 Years of Age or older!

Yes I Agree -::- No I DO NOT Agree

 

Sign Here:_________________________________

 

Parent/Guardian First Name:

Parent/Guardian Last Name:

Parent or Legal Guardian must agree if under 18 years of age.

Yes I Agree -::- No I DO NOT Agree

 

Sign Here:_________________________________

 *** Denotes a Mandatory Field

If you have any questions for MPKA Staff, please add them below:

See who's visiting this page.