SAKUMA INVITATIONAL

SHIAI and KATA COMPETITION

Burlington, Washington - October 22rd, 2011 Sanction # 11-10-02
Competition Location Burlington Edison High School 491 N. Burlington Blvd

Tournament Director Co-Director Head Referee Head Kata Adviser and Judge

Aaron Hillaire Brian Sakuma Calvin Terada Jan Moss

Entries: $30 for entries on/before Oct 20th $35 for entries after Oct 20th $30 per Kata No entries after 8am Oct 22rd

Email: [email protected] Phone: 360-333-6236 Fax: 360-854-0737 Mail: Aaron Hillaire 11579 Panorama Dr Sedro Woolley WA, 98284

Eligibility: USJF, USJI, USJA or Canadian Judo Weigh-ins: 7:00 AM - 8:30 AM, Oct 22rd 2010 Tournament begins at 10:00 AM Referee meeting begins at 9 AM

Current IJF modified contest rules: No Kansetsu Waza & Shime Waza 12 years and under. No Kansetsu Waza 16 and under .and Sr. Novice Double drop knee seio nage will be allowed. Pre- 2003 Medical Rule will ONLY be used in the Jr. 12 & under & Sr. Novice Divisions. Co Ed 10 and under depending on pool. Elimination: Modified Double Elimination. Divisions with 5 or less players will be robin. Winner will be the one who has the most total points. Eligibility: All contestants MUST show proof of valid membership with USJF,USJI, or Judo Canada. USJA, round

Masters (will depend on competitors ) Kata Nage no kata and Katame no kata (other forms will need to give advance notice)

Junior Novice Advance

16 and under teams under black belt teams above black belt teams

Age & Weight Division AGE 5-6 yrs 7-8 yrs 9-10 yrs 11-12 yrs 13-14 yrs 15-16 yrs Novice (4 kyu and under) Brown Black GROUPS M/F M/F M/F M/F M/F M/F M/F M/F M/F WEIGHT L, M, H L, M, H L, M, H L, M, H L, M, H L, M, H L, M, H L, M, H L, M, H MATCH TIME 2 minutes 3 minutes 3 minutes 3 minutes 3 minutes 3 minutes 3 minutes 5 minutes 5 minutes

SAKUMA INVITATIONAL Official Entry Form October 22rd 2011

NAME__________________________________________AGE___________SEX____________ ADDRESS______________________________CITY___________STATE___ZIP____________ PHONE#( )___________________________BIRTHDATE_____________WEIGHT_________ Email:______________________________________________________ JUDO RANK: SR____JR____ KYU____DAN____COLOR BELT_____________DIV________ KATA________FORM OF KATA_______________________UKI_________TORI___________

CLUB___________INSTRUCTOR________________________PHONE#__________________ ADDRESS_________________________CITY_________________STATE________ZIP______

USJF#________EXP_______USJI#________EXP________ USJA#________EXP________CAN#________EXP_______ ALL COMPETITORS AND, IF CONTESTANT IS UNDER 18 YEARS OF AGE ALL PARENTS AND/OR LEGAL GUARDIANS MUST SIGN THE WARNING, WAIVER,AND RELEASE OF LIABILITY AND AGREEMENT TO PARTICIPATE THAT IS ATTACHED TO THE ENTRY FORM. ALL COMPETITORS I,___________________. A JUDO INSTRUCTOR WHO HOLDS THE JUDO RANK OF (MUST BE SHODAN OR HIGHER) UNDER THE AUSPICES OF A NATIONALLY RECOGNIZED JUDO ORGANIZATION (KODOKAN,USJF,USJI,USJA)HEREBY CERTIFY THAT_________________ , A NON-BLACK BELT COMPETITOR IS COMPETENT TO PARTICIPATE IN THE SAKUMA INVITATIONAL TOURNAMENT BEING HELD ON OCTOBER 22rd 2011. _________________________________________________ Instructor Signature Date: _________________________________________________ Participant (please print) Signature Date: _________________________________________________ Parent/Legal Guardian Name Signature Date:

WARNING! WAIVER AND RELEASE OF LIABILITY AND AGREEMENT TO PARTICIPATE (Including Limited Co-Ed Competition for Age 10 and Under for USJF Sanction) In consideration of being permitted to participate in any way, including travel to and from, in any Judo tournament, practice, clinic, and related events and activities (Activity) of the United States Judo Federation, Inc., USA Judo/United States Judo, Inc., United States Judo Association, Inc., Northwest Judo Yudanshakai, Inc., Sakuma Judo Club, and the Burlington Edison High School, I agree: 1. I understand the nature of Judo activities and believe I am qualified to participate in such Activity. I also understand the rules governing the sport of Judo. 2. I further acknowledge that prior to participating, I will inspect the mats, equipment, facilities, competition pools or divisions, and the elimination or scoring system to be used, and if I believe anything is unsafe or beyond my capability, I will immediately advise my coach, supervisor, and/or a tournament official of such conditions and refuse to participate. 3. I acknowledge and fully understand that I will be engaging in a contact sport that might result in serious injury, illness or disease, including permanent disability or death, and severe social and economic losses due not only to my own actions, inactions or negligence, but also to the actions, inactions, or negligence of others, the rules of the sport of Judo, or conditions of the premises or of any equipment used. Further, I acknowledge that there may be other risks not known to me or not reasonably foreseeable at this time. 4. Knowing the risks involved in the sport of Judo, I assume all such risks and accept personal responsibility for the damages following such injury, illness, disease, permanent disability, or death. 5. I hereby release, waive, discharge and covenant not to sue the United States Judo Federation, Inc., USA Judo/United States Judo, Inc., United States Judo Association, Inc., Northwest Judo Yudanshakai, Inc., Sakuma Judo Club, and the Burlington Edison High School, together with their affiliated clubs, their respective administrators, directors, officers, agents, coaches, and other employees or volunteers of the organization, event officials, medical personnel, other participants, their parents, legal guardians, supervisors and coaches, sponsoring agencies, sponsors, advertisers, and if applicable, owners, lessors, and lessees of premises used in conducting the event, all of whom are hereinafter referred to as "Releasees", from any and all litigation expenses, attorney fees, loss, liability, damage or costs on account of injury, illness, disease, including permanent disability and death or damage to property, caused or alleged to be caused in whole or in part by the negligent acts or omissions of the Releasees or otherwise to the fullest extent permitted by law. I HAVE READ THE ABOVE WARNING, WAIVER, AND RELEASE, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND KNOWING THIS, SIGN IT VOLUNTARILY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE. CONSISTENT WITH THE BY-LAWS OF USJF, THIS TOURNAMENT MAY INCLUDE CO-ED COMPETITION FOR AGES 10 AND UNDER IN COMPARABLE AGE/WEIGHT DIVISIONS WHERE THERE IS AN INSUFFICIENT NUMBER OF GIRLS FOR NON-CO-ED AGE/WEIGHT DIVISIONS. I HAVE READ AND UNDERSTAND THE TOURNAMENT ANNOUNCEMENT CONCERNING THESE SPECIAL DIVISIONS. I AGREE TO PARTICIPATE KNOWING THE RISKS AND CONDITIONS INVOLVED AND DO SO ENTIRELY OF MY OWN FREE WILL. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENT/LEGAL GUARDIAN AS EVIDENCED BY THEIR SIGNATURE BELOW. I INTEND THIS TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THAT THE BALANCE, NOTWITHSTANDING SHALL CONTINUE IN FULL FORCE AND EFFECT. __________________________________ Participant ______________________________ Participants Signature _________________ Date

FOR PARENTS/LEGAL GUARDIANS OF PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT TIME OF REGISTRATION) This is to certify that I, as parent/legal guardian with legal responsibility for this participant, do consent and agree to his/her release, as provided above, of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor childs involvement or participation including litigation expenses, attorney fees, loss, liability, damage or costs which may incur as the result of the minor childs participation in these programs as provided above, even if arising from their negligence, to the fullest extent permitted by law. I have instructed the minor participant as to the above warnings and conditions and their ramifications. __________________________________ Parent/Legal Guardian ______________________________ Parent/Legal Guardians Signature _________________ Date
Form 514, V6.0.0, 090818