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

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

Divisions Please Circle Appropriate Division

Yellow - Brown : Little Dragons

White Belt: Mites Kids Youth Adult

Yellow/Orange Belt: Mites Kids Youth

Green/Purple/Blue Belt: Mites Kids Youth

Red/Brown Belt: Mites Kids Youth

Novice (Yellow, Orange, Green Belts) : Adult

Advanced (Blue, Purple, Red, Brown Belts) : Adult

1st Degree Black Belt: Youth Adult

Advanced BlackBelt: Adult

Little Dragon: 6 and Under (Yellow through Brown)
Mites: Ages 7 to 9
Kids: Ages 10 to 12
Youth: Ages 13 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)