The Shuai Chiao Kungfu Club
at The Ohio State University
Year of the Rooster
Tournament Entry Form
Saturday, November 4th, 2017, 9:00 am
RPAC, The Ohio State University, Cols.
OH
Name: ________________________________________________
Address:________________________________________________
________________________________________________
________________________________________________
Phone:______________________
Shuai Chiao Rank:__________
Weight:______ Height:_______
Sex: M___ F___
Club/School:____________________________________________
Notify in case of emergency:
Name:___________________________________________________
Phone:_____________________
Relationship to you:________
Address:________________________________________________
RELEASE OF ALL CLAIMS
In signing this form, I hereby for myself, my heirs, executors,
and administrators, assume all risk of injury, and waive and release any
and all rights and claims for damages I may have against the Shuai Chiao Kungfu
Club at The Ohio State University and The Ohio State University, their instructors,
assistants, employees, representatives, or assigns; all other participants;
local facility managers, owners, and advisors; for injuries or damages
which may be suffered by me as a result of attending, participating in, practicing
for, or traveling to or from this event. I release rights for photographs
or videos taken at this event. I understand that any immediate medical assistance
will be of a first aid nature only. I understand that Shuai Chiao Kungfu
is a throwing art that may involve impact with the ground and heavy contact
with other participants and that there are inherent risks in participation
that cannot be eliminated completely and that, while full safety precautions
will be taken in the practice and teaching of Shuai Chiao techniques and
exercises, any vigorous movement art has the potential to cause serious and
even life-threatening injuries. Such injuries may range from minor
abrasions, contusions, and sprains to rare, but major, injuries such as broken
bones, dislocations, stroke, heart failure, and neck and spine injuries that
may result in paralysis or death. I certify that I have had a physical
examination by my physician, am in good health, and am voluntarily participating
in kungfu practice with full knowlege of the potential dangers. I accept
any and all risks of such bodily injury. I certify that I have insurance
coverage that is applicable for potential injuries such as described above.
Signature:_____________________________ Date:___________
Parent or Guardian:_______________________________
Date:_____________
-- Do not make entries in this area -- tournament
official use only --
Entry Fee: $25 No entries accepted
after 9:30am, November 4th
Make checks payable to: Shuai Chiao Kungfu
Club at OSU
Fee Paid:____ Check#/Cash:________ Received
by:____________
Year of the Rooster -- click here for OSU Waiver Form
Year of the Rooster -- click here for OSU minor Waiver Form
Year of the Rooster -- click here for Rooster Tournament Entry Form .pdf
Year of the Rooster -- click here for Directions to Rooster Tournament
USA Shuaijiao Tournament Rules
Year of the Fire Rooster Tournament
More Information:
Saturday, November 4th, 2017
Location: in the RPAC building: The Ohio State University, Columbus, Ohio.
Start time: 9:00am - all contestants must be on-site, registered, and weighed-in by 9:30am.
ALL attendees; contestants, coaches, and observers, must pre-register by October 21st to
be on the OSU event roster to gain access to the RPAC building
tournament area. Register all attendees by sending an email to Mike
Grigsby with a roster listing first and last name. Contestants should
also list their weight.
All contestants must fill out an OSU Waiver form, and a Rooster
Tournament registration form. These documents are available above in
printable HTML and .pdf formats. The forms can be mailed in advance, or
brought the day of the event. The tournament entry fee is only $25.
There is no charge for observers, but seating is very limited.
The planned weight divisions are as follows:
Men's divisions:
Lightweight 120-140
Welterweight 141-160
Middleweight 161-180
Heavyweight 181-200
Openweight 200-300
Women's divisions:
Lightweight 80-125
Welterweight 126-150
Middleweight 150-200
These divisions are subject to change the day of the tournament: please
do not plan to cut or add weight just to make a division.
If you have any questions, please contact me by email.
Mike Grigsby, Tournament Coordinator
The Shuai Chiao Kungfu Club at OSU
mailto:sifu@osukungfu.com