2020 VA AAU State Championship

Participant Contact Information

Athlete Name

Parent or Guardian

Phone Number

Address

City, State and ZIP Code

Registration Information

2020 AAU #

Dojo

Sensei Name

Gender

Male
Female

Date of Birth

Age (current age for Invitational only)

Age/Division

Weight (lbs.)

Experience

Choose one

I will compete in the following

Charted Flag Kata (Adv belts ages 14 and up ONLY)

Kobudo Long/Short Combined (All levels)

PeeWee (age 4)

Kata

Kumite

Rotational Kumite

FREE

Special Talents/Special Needs

Medical Information

Fee(s)

Early Bird Registration: Received by April 3, 2020 - $70

Regular Registration: Received April 4-13 - $85

On-site Registration - $100

Pee Wee Registration - Ages 4 and under ONLY $10

Rotational Kumite - FREE

Registration

Total

$0.00

Waiver

Parent or Guardian if under 18yrs. of age

I here by for myself, my executor(s), my heirs, forever and always agree to save and hold harmless the Amateur Athletic Union of the United States
and all of its officers, referees, judges, volunteers, workers, members, tournament director, tournament promoter, tournament employees, the facility
owners, their Respective officers, participating in, or other direct or indirect involvement in the AAU/USA karate Tournament that I have entered. In
addition, I hereby for now and forever, accept any and all responsibilities for any actions in conjunction with the AAU/USA Karate Tournament and
the traveling to or from or participating in said event. Finally, I agree to allow, without compensation, the use of any photographs, films, or videotape
of myself

I have read and agree to the terms above.