Introduction to Refereeing Clinic event information and entry form

Ojukan NW Referee Clinic 2015 Waiver standard USJF waiver form

Northwest Judo Yudanshakai

Introduction to Refereeing Judo Clinic

Ojukan Judo Dojo (ojukanjudo.org)

 

Sanction # 15-02-10

Oregon National Guard Armory

848 NE 28^th Avenue

Hillsboro, OR 97124

Saturday February 7^th, 2015

 

 

• Learn the basics of refereeing.
• Improve coaching techniques.
• Gain an advantage as a competitor.
• Prepare for regional referee examination.
• Open to current members of the USJA, USA Judo/USJI, or USJF, at least 16 years of age, and holding a rank of green belt or higher.  Must present current membership card.

 

When:

February 4^th, 2015

• 10:00-12:00pm Classroom
• 1:00-3:00 Practical

 

Where:

Hillsboro Armory

848 NE 28^th Ave.

Hillsboro, OR 97124

http://ojukanjudo.org/home-of-ojukan/location/

 

Cost:

$20 per person (Includes Lunch)

$5 discount per person for groups of three or more from any one dojo

 

Advanced registration is not required, but RSVP is appreciated

 

Contact

Tim Reynolds

(503) 502-5685

tdrey2005@gmail.com

Registration Form

Sanction # 15-02-10

Attendee Information

Name (PRINT)
Rank
Club
□ USJF      □ USA Judo□ USJA	Member #Expiration Date (mm/dd/yyyy):
Address – STREET
Address – CITY/STATE/ZIP
eMail

 

Special NeedsIf assistance/accommodation is needed (check off appropriate box): □ Vision Loss/Blindness     □ Hearing Loss/Deafness Type of assistance/accommodation requested or name of person assisting: ____________________________________________________________________

 

Parent/Legal Guardian Consent for Judoka under 18 years of Age:

I, the undersigned parent or legal guardian of the named student:

______________________________________________­­­­­­­_______________, (print name of student)

Understand the method and risk of instruction for this referee clinic.  I have agreed to allow my child to participate in this event.

_____________________________________________________    _________________

Parent/Guardian Signature                                                                  Date