Print Tournament Flyer

Complete the tournament registration form below.  You may use PayPal for payment.

If you are human, leave this field blank.

Name & Address

Name *

GENDER * Male Female

Addess *

City *

State *

Zip *

Phone Number *

Email Address *

Parents Name

Instructors Name

I, We, or parent(s) of the above named person(s) who is/are participating in the above named martial arts event, hereby give my/our approval to his/her participation in any and all of the activities of the class. I/We assume all risks incidental to the conduct of the class. I/We do further release, absolve, indemnify, and hold harmless Lenexa Karate Academy, the sponsors and supervisors, agents and employees, any or all of them. In case of injuy to my/our child/children or myself, I/We hereby waive all claims against the organizers, sponsors or any of the supervisors appointed to them. I/We likewise release any person transporting my/our child/children or myself, to or from the class or activity. I/We would furnish a birth certificate if so requested by Lenexa Karate Academy

Electronic Signature *

AGE *

6 & Under 7 - 9 yr. 10 - 12 yr. 13 - 14 yr. 15 - 17 yr. 18 - 32 yr. 33 & over

BELT COLOR *

White Yellow Orange Blue Green Purple Brown / Red Black

WEIGHT * 50 lbs & under 51 to 65 lbs 66 to 75 lb 76 to 90 lbs 91 to 120 lbs 121 to 160 lbs 161 to 204 lbs 205 lbs and over

EVENTS *

Team Kata

Weapons Kata

Kata

Sparring