2014 TAE KWON DO COMPETITION ENTRY FORM
Please complete the entire entry form and sign where asked. Mail or drop off this form with the entry fee to:
Master Song’s Martial Arts School, 40 ½ Padanaram Road, Danbury, CT 06811
Phone: (203) 743-3315
Website: www.mastersongtkd.com
Fax: (203) 743-6553
Email: [email protected]
APPLICANT INFORMATION
Last Name:
First Name:
Date of birth:
Phone:
Evening Phone:
Address:
City:
State:
Participant Gender:
Male
Female
ZIP Code:
(Please circle)
Age:
Weight (Sparring):
Email address:
Belt Rank:
TKD School:
EMERGENCY CONTACT
Name (First and Last):
Relationship:
ENTRY CODE FOR INDIVIDUALS
Phone:
(YOU CAN CHOOSE ONE OR BOTH)
 Forms: Division______
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Division
Division
Division
Division
Division
Division
Division
Division
I: (5 and younger) Tip Belts
II: (11 and younger) No belts, White, and Yellow belts
III: (11 and younger) Orange, Green, and Purple belts
IV: (11 and younger) Blue, Red, and Brown Belts
V: (12 and older) No belts, White, and Yellow Belts
VI: (12 and older) Orange, Green, and Purple Belts
VII: (12 and older) Blue, Red, and Brown Belts
VIII: (All ages) Black Belts
 Creative Forms
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All ages are allowed to enter
Students are allowed to use a weapon
Time limit is 1:00 minute
 Group
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Minimum of 3 people in a group
All ages are allowed to enter
Students are allowed to use a weapon
PAYMENT INFORMATION
(PLEASE MAKE CHECKS PAYABLE TO MASTER SONG’S MARTIAL ARTS SCHOOL)
*REGISTRATION FEES AND TICKET FEES ARE NON-REFUNDABLE
Check One:
Check
Money Order
Master Card
Visa
Discover
Cardholder Name (Please Print):
Card Number:
Exp. Date:
Signature (Required):
HOW DID YOU HEAR ABOUT US?
Check One:
Parent/ Coach
Poster
Internet
Media
Other (Specify)
ATHELETE’S WAVIER, PLEDGE AND CONSENT AGREEMENT
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I n cons i derati on of the a ccept ance of my e nt ry i nto the competi ti on know n as 2014 T ae K won Do Competi ti on, I , i nten di ng to b e l egal l y bound, do hereby for mys el f, my hei rs , executors and
admi ni s trators , wai ve, rel eas e and foreve r di s charge a ny and al l ri ghts and cl ai ms for da mages , i ncl udi ng any cl ai ms for l os s , damages or i njury to my own pers on or property a ri s i ng out of t he
performan ce or fai l ure of perfor mance of t he 2014 T ae K won Do Competi ti on, Mas ter Son g’s Marti al Arts Sc hool , and any and al l s pon s ors , groups provi di ng s ancti on or approval , owner of s i tes , and/or
the res pe cti ve offi ce r/agen ts , repres enta ti ves , s ucces s ors and/or as s i gns of the parti es na med above for any an d al l cl ai ms f or dama ge to pers on or prop erty s us tai ned by me i n co nnecti on wi th,
as s oci ati on or entry i n, and /or ari s i n g from a cti vi ty rel ated to the 2014 T ae K won Do Com peti ti on. I have ful l knowl edg e that the s port i n whi ch I have e ntered car ri es s i gni fi ca nt ri s k of pers onal i njury,
i n s ome cas es very s evere i nj ury, even death . I al s o agree that I am r es pons i bl e for my o wn s afety. I de cl are that to my bes t o f my kn owl edge, I am i n good phys i cal condi ti on and have no di s eas e or
i njury that woul d be a ggravated by my pa rti c i pati on i n acti vi ti es rel ated to the 2014 T ae K won Do Competi ti on. I , al s o, decl a re on my h onor that I am an amat eur a nd ful fi l l the con di ti ons s ti pul ated by
the 2014 T ae K won Do Compe ti ti on. I agree t hat i f I am s el ect ed for competi ti on at the Fi nal s of the Com peti ti on, I wi l l comp ete i n t he competi ti on, keep mys el f i n top p hys i cal con di ti on, retai n my
amateur s tat us and make mys el f avai l abl e for trai ni ng w henever and when ever pos s i bl e. I wi l l al s o appear and parti ci pate i n the O peni ng Cere moni es and r eport to t he pres s for pi ctures , i ntervi ews , as
di rected by the 2014 T ae K won Do Competi ti on authori ti es , k nown as Mas ter So ng’s Marti al Arts School . I un ders tand that the cons um pti on of al cohol i c bevera ges or non -pres c ri be d drugs at any 2014
T ae K won Do Competi ti on ven ues , events or dormi tori es i s s tri ctl y prohi bi ted and t hat fai l ure to co ndu ct mys el f i n a s oc i al l y res pons i bl e manne r (to be determi n ed by t he 2014 T ae K won Do aut hori ti es )
wi l l res ul t i n i mmedi ate expul s i on from t he 2 014 T ae K won Do Competi ti on. I hereby cons ent to al l ow my pi ctu re or l i kenes s to appea r i n any of fi ci al docume ntary, s pons or adve rt i s ement or excl us i ve
tel evi s i on coverage of the 2014 T ae K won Do Competi ti on i n any mann er i nci de ntal to my parti ci pati on i n t he 2014 T ae K won Do Comp eti ti on and wi thout compe ns ati on to me. I de cl are that I have
pers onal medi cal coverag e and that I have re ad al l the above a nd u nders ta nd the rel eas e and wavi er, and by s i gni ng i t I agree to al l i t s i tems .
BY ENT ER ING A ND P A R T ICIP AT ING IN T HE 2014 T AE KWON DO COM P ET IT ION, A LL A T HLET E ’S A GR EE T O A BID E BY T HE RULES , R EGULA T IONS A ND DIS CIP LINA R Y A CT IONS OF T HE
COM P ET IT ION A DM INIS TR T AT OR S .
I T I S T HE RE SPO NSB I LI T Y O F T HE AT HLET E T O FO LLO W ALL RU LE S. FAI LTU RE TO DO SO MAY RE SU LT I N SU SPE NSI O N, E XPU LSI O N AND/O R FO RF E I TU RE.
Athlete’s Signature:
Date
Parent/Guardian Signature (if participant is under 18):
Date
**PLEASE MAKE SURE TO INCLUDE:
PROOF OF AGE
ENTRY FORM
APPROPRIATE FEE
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2014 Tae Kwon Do Competition
Date: Columbus Weekend, Saturday, October 11, 2014
Time: Starts at 9am
Place: Master Song’s Martial Arts School
Price: $75 per participant, $25 for each additional event , and $5 for audience ticket
* Final day to submit application is Saturday October 4, 2014 and after that date Late Registration is $85
** Space is limited to first 100 participants and each participant is limited to 3 audience tickets
Rules for Competition
Competitors will perform WTF (Olympic) recognized forms only.
 White Belts- Brown Belts: Taeguek (Forms)
 Black Belts: Koreyo, Guemgang, Taebaek, or PyongWon forms
Scoring: 2 Categories: Artistic & Skills
 Competitors will be judged on the following: concentration, balance, focus, grace , strength, snap,
shout, height of kicks & correct kicks, proper stances, and knowledge of the form
 Score will range from 1 to 10 points
 Competitors with highest total score win
 In the event of a tie, the Referee/Judge will organize a head to head rematch (max. of the 3
competitors at a time.)
Elimination Rounds:
 All compete
 Select Top 10 from the division
 Top 10 perform again to select Top 3
 NOTE: If there are a lot of competitors, they will compete 2 at a time.
Placing:
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One 1 st , 2 nd , 3 rd place trophies per division will be awarded
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Only divisions 11 and younger will get participation medals besides 1 st , 2 nd , and 3 rd place trophies
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Grand Prize Winner will receive the Grand Prize of $500 and a 6ft trophy
Mandatory Equipment/Attire for Forms:
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Standard white V-neck TKD uniform only
Mandatory Equipment/ Attire for Creative Forms and Group:
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Weapons (if using weapons in creative form or group)
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Music CD or iPod
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Attire other than standard white V-neck TKD uniform is allowed
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For creative forms: A time limit of 1:00 minute is allowed, but if the participant goes over the time
limit, a point will be deducted from their score.
Final Scoring
All competitors that earned 1 st place in each division will compete for the Grand Prize scholarship of $500.
Total of 10 points will be awarded by audience through texting poll.
*NOTE: If there is a tie the “Golden Score” will be awarded by the audience’s vote to the final winner.
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