Competitor Entry Form
Competitor Information   *required
First Name*
Last Name*
Address*
City*
State*
  Zip Code*
Home Phone*
E-mail*
Date of Birth*
 
Gender*
  
Rank*
Dan— Degree  
Geup       
Color Belt
Your Taekwondo School Information   *required
School Name*
School Address
School City
School State
 Zip Code
Instructor’s Name
School Phone
School E-mail
WTF Format Poomsae
Individual
Open Pairs
  List Pairs Partner
Open Team
  List Team Member 2
  List Team Member 3
Freestyle
Registration is $60 one event/ $15 each addition event
LIABILITY WAIVER (Check in agreement with Liability Waiver)
In consideration of your acceptance of my entry, I do hereby for myself, my heirs, executors and administrators waive, release and forever discharge any and all rights and claims for damages which I may have or may accrue to me against Connecticut Chung Do Kwan, LLC, Town of Colchester and all members of the tournament or their respective officers, agents, representatives, successors, and/or assigns and against any competitor for any and all damages which may besustained by me in connection with my association with, or entry, in the above athletic meet, or which may arise out of traveling to, participating in, and returning from such athletic meet. I understand that Taekwondo is a body contact sport, and I further understand all the contents, rules and general information by which the tournament operates.
Total Amount Due $
Payment Information (Secure Transaction)   *all fields required
VISA and MasterCard accepted
Credit Card Number*
Expiration Date (mm/yy)*
First Name*
Last Name*
Address*
City*
State*
Billing Email Address*
 
  Check the box above to enable the Submit button.
 
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