2009 CMAWNY CHALLENGE TOURNAMENT MARCH 7, 2009 - Weopons
Must Fill Out A Separate Sheet for SPARRING & FORMS & SELF DEFENSE

Name: _________________________________ Age: ______________
Belt Rank: ______________________________ Dojo: _______________________ E-Mail : ________________________
Dojo Address: ________________________________________________________________
Instructor: _____________________________________________________________________

Divisions Please Circle Appropriate Division

Under BlackBelt: Youth Adult

BlackBelt: Youth Adult

Kids: Ages 11 and Under
Youth: Ages 12 to 16
Women/Men Ages 17 and Up

Make Checks Payable to: Christopher D. Gonnoud

Mail Forms to: 37 Webster Road, Spencerport, NY 14559

Fees:
Before Feb 21, 2009: One Event = $30 // Two or More Events $40
Door Price: One Event $40 // Two or More Events $50

Family Discounts: 2nd Family Member: Two Dollars Off Fee 3rd and Beyond: Five Dollars Off Fee

Waiver: I am aware that the martial arts involves physical activities which may result in my being injured. I hereby voluntarily submit this waiver for attendance and participation in the Tournament being held at Taylor Elementary, directed by Christopher D. Gonnoud (Community Martial Arts of Western NY) and in consideration for my attendance in the tournament, being ever mindful of the risks, do hereby assume full responsibility for any and all damages, injuries or losses that I may sustain or incur, if any, while attending or participating in said tournament or activities related hereto or conducted therein, and hereby waive all claims against instructors, operators and sponsors of said tournament and, individually or otherwise, for any claim for injuries that I may sustain. Furthermore, I agree to indemnity and to hold harmless the instructors, operators and sponsors of said tournament, individually or otherwise, from liability arising out of my own negligence or intentional acts.

Signature: _______________________________________

Parents Signature: _________________________________ (If person is under 18 yrs of age)