Regional Tournament Registration Form
Taekwondo America
Summer Regional Championships: July 20, 2013
Sports Connection - Northlake
8626 Hankins Rd. Charlotte, NC 28269
These times are estimates. Times will vary depending on the number of competitors.
Setup and Judges Meeting (All Levels)
Adult Black Belts (ages 14 years and up)
Junior Black Belts (up to 13 years old)
Introductions
Junior Dragons, White, Yellow and Orange Belts
Junior Green, Sr. Green, Purple, Sr. Purple Belts
Junior Blue and Sr. Blue
Junior Brown and Sr. Brown
Junior Red and Sr. Red
All Adult Men and Women White – Sr. Red Belts
including VIPs
REGISTRATION FEE:
ADMISSION:
8:30 am
9:00 am
10:30 am
11:30 am
12:00 pm
12:30 pm
1:00 pm
1:30 pm
2:00 pm
2:30 pm
$60 per Participant
$30 for 3rd Family Members
$5 per Spectator at the door
Name
Date of Birth
Rank
Gender
TA School
Chief Instructor
Age
Men (14 -30 Years old):
1. 3rd and 4th Degree
2. 2nd Degree
3. 1st Degree
4. Red/ Sr. Red
5. Brown/ Sr. Brown
6. Blue/ Sr. Blue
7. Purple/ Sr. Purple
8. Green/ Sr. Green
9. Orange/ Sr. Orange
10. White/Yellow
JUNIORS (up to 13 years old):
21. 2nd Degree
22. 1st Degree
23. Red/ Sr. Red
24. Brown/ Sr. Brown
25. Blue/ Sr. Blue
26. Purple/ Sr. Purple
27. Green/ Sr. Green
28. Orange/ Sr. Orange
29. White/ Yellow
30. Dragons, Tigers, Etc
WOMEN (14-30 Years old):
11. 3rd Degree
12. 2nd Degree
13. 1st Degree
14. Red/ Sr. Red
15. Brown/ Sr. Brown
16. Blue/ Sr. Blue
17. Purple/ Sr. Purple
18. Green/ Sr. Green
19. Orange/ Sr. Orange
20. White/ Yellow
VIP (30+ years old):
31. MEN: 1st – 3rd Degree
32. MEN: Red/ Sr. Red
33. MEN: Brown/ Sr. Brown
34. MEN: Blue/ Sr. Blue
35. MEN: Purple/ Sr. Purple
36. MEN: Green/ Sr. Green
37. MEN: Orange/ Sr. Orange
38. WOMEN: 1st – 3rd Degree
39. WOMEN: Red/ Sr. Red
40. WOMEN: Brown/ Sr. Brown
41. WOMEN: Blue/ Sr. Blue
42. WOMEN: Purple/ Sr. Purple
43. WOMEN: Green/ Sr. Green
44. WOMEN: Orange/ Sr. Orange
45. ALL VIP White/ Yellow
REQUIRED EQUIPMENT: Complete and clean uniform and belt
with ALL required patches. Complete and clean set of Taekwondo
America approved sparring gear: mouthpiece, elbow pads, shin
guards, hand gear, feet gear, head gear, and groin cup (for males
only).
TAEKWONDO AMERICA COURTESY POLICY
Any competitor, spectator, parent or judge exhibiting unsportsmanlike
conduct or interfering with the positive competitive atmosphere of this
tournament will be asked to leave the facility.
Remember and practice the Tenets of Taekwondo: Courtesy,
Integrity, Perseverance, Self-Control and Indomitable Spirit.
Accommodations: Comfort Suites Northlake
7315 Smith Corners Blvd
Charlotte, NC 28269
Rates starting at $78/Use code: Taekwondo America
JUNIORS: up to 13 years old
ADULT: 14 to 30 years old
VIP: 30 years old
Registration Agreement and Waiver
Tournament Registration Fee:
Level 3 or 4:
3rd Family Member:
Registration Fee:
$60
FREE
$30
$ __________
Yes, I would like to pre-order my Regional Tournament tshirt for $20. The last day to pre-order t-shirts is July 8th,
2013. T-shirts will be $25 on the day of the tournament.
Please circle size:
CS
CM
CL
AS
AM
AL
XL
T-Shirt:
$ __________
Total:
$ __________
XXL
HOLD HARMLESS AGREEMENT
NOTICE: TaeKwonDo America and its agents urge all competitors to obtain
physical examinations from their physicians prior to tournament competition.
I have full knowledge that, by nature, tournament participation may frequently
include strenuous exercise and body contact along with their associated
dangers. In recognition of the possible dangers connected with any physical
activity, member(s) knowingly and voluntarily waive any right of cause of
action of any kind whatsoever arising as a result of such activity from which
any liability may or could accrue to Josh Martin, Ashley Martin, Julee Peck,
Warren Davis, Sean Baxter, Sean Wilson, Phuoc Dang, Zak Scott, Sean
Abbott, Jacob Burdge, David Church, Dwaine Chan, Brian McCoy, James
Rich, Michael Cunningham, Elite Taekwondo Systems, LLC, or their agents,
officers, employees, or instructors.
I agree to waive claims against any person(s) or organization(s)
connected with the 2013 TaeKwonDo America Summer Regional
Championships for any injuries that I might sustain. I likewise assume full
responsibility for all actions in connection with said championships.
I agree that tournament directors for publicity or promotion may use any
pictures taken of or by me in connection with said championship without
compensation at this time or any other time.
I, the undersigned, do hereby voluntarily submit my application for
registration in the 2013 TaeKwonDo America Summer Regional
Championships. I further state that a current Agreement of Release is on file
with my TaeKwonDo America licensed school or club.
Participant Signature
Date
Parent or Guardian Signature (If under 18)
Date
2013 TAEKWONDO AMERICA
Summer Regional Championships
July 20th, 2013
Sports Connection – Northlake
8626 Hankins Road
Charlotte, NC 28269
www.sportsconnectionnc.com