[Dl-members] Notice: Washington State Games

Thu May 19 21:35:04 EDT 2011

The body of this message (below) is taken right off of the attached form.

ENJOY!

Washington State Games Judo Tournament
Fund Raising Event for the 2012 USJF Junior Nationals
4th of July Weekend in Spokane, Washington
Hosted by Budokan Judo Dojo
Sanction: USJF #11-06-19

Tournament Date: Saturday, June 18, 2011

Time: Registration 7:00-7:30am (Kata)
Weigh-in 7:30-9:00am (Jr) 10:00-11:30am (Sr)
Kata Competition 8:00am
Referee Meeting 9:00am
Shiai 10:00am (Jr)

Eligibility: All contestants must be an amateur athlete and have a current
membership with USJF, USJA, or USA Judo
Tournament Site: Shorewood High School
17300 Fremont Avenue North
Seattle, WA 98133-5249
Information: Washington State Games
c/o Aaron Scrol
12427 79th Ave. S.
Seattle, WA 98178
ascrol at u.washington.edu
206-722-5059
Entry Fee: $30.00 (US)
Entries: Included in this information package is the (a) registration form,
(b) non-black belt form, and (c) two (2) separate waiver forms per
judoka: Washington State Games &USJF. Please return all entry
and waiver forms to Aaron Scrol by June 15, 2011. Late entries
will be charged $75.00
Chief Referee: Calvin Terada, IJF-A
Referee Certification: NW Judo “Regional” certification available by NW Judo
Referee Committee. Testing will begin promptly at 8:00am
(written examination & $25 exam fee)
Kata Competition: Nage-no-Kata (only in a single division) – All female, all male,
mixed pair
Tournament Rules: Current IJF rules will be used with the following modifications:
- Shime waza (choking) allowed only for 13 years and older
- Kansetsu waza (arm locks) allowed for all senior divisions
- Co-ed competition for children 10 yrs and younger may occur
depending on number of entries per division
- Mandatory blue/white judo-gi use for all divisions
Tournament Format: Modified Double Elimination
Age & Weight Division:
AGE GROUPS WEIGHT MATCH TIME
5-6 yrs M/F L, M, H 2 minutes
7-8 yrs M/F L, M, H 3 minutes
9-10 yrs M/F L, M, H 3 minutes
11-12 yrs M/F L, M, H 3 minutes
13-14 yrs M/F L, M, H 3 minutes
15-16 yrs M/F L, M, H 3 minutes
Novice (4 kyu and
under)
M/F L, M, H 3 minutes
Brown M/F L, M, H 5 minutes
Black M/F L, M, H 5 minutes
Tournament Entry Package:
(1) Tournament Information
(2) Tournament Registration
(3) Non-black belt form
(4) USJF Waiver
(5) Washington State Games Waiver
(6) Map and Directions to the Tournament Venue
OFFICIAL ENTRY FORM
June 18th, 2011
(PLEASE TYPE OR PRINT)
NAME: ____________________________ AGE: ________ SEX: Male Female
ADDRESS:______________________ City:________________ State:______ Zip:_______
PHONE#: ( ) ________ - _______ EMAIL: ____________________________
BIRTH DATE: _________________ WEIGHT_______LBS.
DIVISION: (Please Check All Divisions You Will Compete In)
Junior Senior Novice Senior Brown Senior Black Master (40yrs+)
RANK: (Please Check One)
Junior Ranks:
White
Yellow
Orange
Green
Blue
Purple
Senior Ranks:
White
Green
Brown
Black Belt Rank: _______Dan
YOU MUST PRESENT ONE OF THESE CARDS AT WEIGH-IN!)
USJF#__________expires________USJI#___________expires_________USJA#__________expires__
_____
JUDO CLUB _________________________Instructor______________________
Phone ( ) _______ - ________
ADDRESS_______________________City___________State________Zip_________
Mail Entries to:
c/o Aaron Scrol
12427 79th Ave. S.
Seattle, WA 98178
Or Register Online at www.budokanjudoseattle.com
Certificate Regarding Non-Black Belt Contestants
I,
Print name of instructor
a Judo instructor, who has been awarded the Judo rank of Shodan or higher,
under the auspices of the USJI, USJF, USJA, or a Nationally recognized
Judo organization hereby certify that,
,
Print name of contestant
although not having been awarded the Judo rank of Shodan or higher, is of
sufficient aptitude and skill in Judo to compete in this competition.
______________________________________
Judo Instructor (print)
Signature of Judo Instructor Date
Rank
Organization rank obtained through
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 the 2011 Washington State Games
Judo Tournament, 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, Budokan Dojo, Inc., Washington State Judo, Inc., Japanese Cultural 
and Community Center of
Washington, Shoreline School District, Shorewood High School, and Affiliated 
local Judo Associations, 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, Budokan Dojo,
Inc., Washington State Judo, Inc., Japanese Cultural and Community Center of 
Washington, Shoreline School
District, Shorewood High School, and Affiliated local Judo Associations, 
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 Participant’s 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 child’s involvement
or participation including litigation expenses, attorney fees, loss, liability, 
damage or costs which may incur as the result
of the minor child’s 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 Guardian’s Signature Date
Form 514, V6.0.0, 090818
Washington Games II Waiver and Release of Liability
PLEASE READ BEFORE SIGNING
In consideration of being allowed to participate in the Washington Games 
athletic/sports program, related events and
activities, I,______________________________, the undersigned acknowledge, 
appreciate and agree that:
Name of Participant
1. The risk of injury from the activities involved in this program is 
significant, including the potential for
permanent paralysis and death, and while particular rules, equipment, and 
personal discipline may reduce
risk, the risk of serious injury does exist; and
2. I knowingly and freely assume all such risks, both known and unknown, EVEN IF 
ARISING FROM THE
NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my 
participation; and
3. I willingly agree to comply with the stated and customary terms and 
conditions for participation. If,
however, I observe any unusual significant hazard during my presence or 
participation, I will remove
myself from participation and bring such to the attention of the nearest 
official immediately; and
4. I, for myself and on behalf of my heirs, assigns, personal representative and 
next of kin, hereby release and
hold harmless the Evergreen State Amateur Athletic Council, their officers, 
officials, agents and/or
employees, other participants, sponsoring agencies, event venues/facilities, 
advertisers and if applicable,
owners and lessors of premises used to conduct the event (releasees) with 
respect to any and all injury,
disability, or loss or damage to person or property, whether arising from the 
negligence of the releases or
otherwise.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT AND FULLY
UNDERSTAND ITS TERMS. I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY
SIGNING IT, AND, I SIGN IT FREELY AND VOLUNTARILIY WITHOUT INDUCEMENT.
__________________________________________ Age: ____________ Date Signed: 
_________________
Participant Signature
FOR PARTICIPANTS OF MINORITY AGE
(Under the age of 18 at the time of registration)
This is to certify that I, as parent/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 the Releasees from any and all liabilities incident to my 
minor child’s involvement or
participation in these programs as provided above, EVEN IF ARISING FROM THE 
NEGLIGENCE OF THE
RELEASSES, to the fullest extent permitted by law.
__________________________________________ Date Signed: __________________
Parent/Guardian Signature
6
Directions to Shorewood High School
Washington State Games Judo Tournament
17300 Fremont Avenue North
Shoreline, WA 98133
 From North or Southbound I-5:
(1) Get off on the North 175th Street Exit
(2) Head west on North 175th Street and cross Aurora Avenue North
(3) Turn Left on Fremont Avenue North
(4) Shorewood High School will be on your left

-------- Original Message --------
Subject: 	Fw: Correct Version of the 2011 State Games Entry Packet
Date: 	Wed, 18 May 2011 23:36:04 -0700
From: 	Yamada Judo Dojo <yamadadojo at hotmail.com>

Washington State Games
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