First Name: Last Name: Age: Sex: M F

Martial Arts Gym & State: Rank: Weight (in pounds):

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I, the undersigned do acknowledge that if this application is accepted, I intend to be legally bound for myself and my heirs, and forever waiver and release Amanda Wach, Fergus Falls/Elbow Lake Tae Kwon Do, their instructors and officers, property owners or trustees, and all tournament officials from all liability for any injuries, fatal or otherwise, attained while traveling to and from or participating in the Fergus Falls/Elbow Lake Tae Kwon Do Open.

I understand that I do have and am responsible for my own health insurance and liability insurance for my own protection, and if I am not covered by any health insurance policy I am still responsible for my own medical coverage, and that if I am under eighteen years of age, this application must be signed by my parent or legal guardian.

I also understand that Tae Kwon Do is a contact sport and I consent upon my own wishes to compete and of fully be responsible for my own injuries even unto death.

I Agree and am over 18 years of age

Name of Parent or Guardian if under 18:

Please select the events you will be competing in: