This event marks our Karate Program’s (ASKA-American Shotokan Karate
Academy) 15th Anniversary in Killeen Texas as well as Sensei Jackson’s 40th
Anniversary in the Martial Arts. We hope that all our friends and family will be
in attendance ...for this Historic celebration. This Tournament (March 24,
2012) marks a very important time in the not only Sensei Jackson martial arts
career, but in the lives of all the karate students that our program has had the
opportunity to influence in a positive matter. We, at ASKA, give all thanks to
God for allowing us to be his tools in which we are enable to guide the
children, teenagers and adult to be all they can be… Osu!
Academy) 15th Anniversary in Killeen Texas as well as Sensei Jackson’s 40th
Anniversary in the Martial Arts. We hope that all our friends and family will be
in attendance ...for this Historic celebration. This Tournament (March 24,
2012) marks a very important time in the not only Sensei Jackson martial arts
career, but in the lives of all the karate students that our program has had the
opportunity to influence in a positive matter. We, at ASKA, give all thanks to
God for allowing us to be his tools in which we are enable to guide the
children, teenagers and adult to be all they can be… Osu!
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| Tournament Registration $65.00 $65.00 for 1-2 Events Please cut and paste bring form with you to tournament |
Please print all information
Name_________________________ Birthday_______(student's age_____Phone_____________
Address______________________________ City___________________State____ Zip___________
Dojo_________________ Phone ___________________Your E-mail______________________
Instructor_______________________ Style __________________________________
Time training
Kyu -Rank (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) Dan Rank Black Belt___________
Kata (forms)_____ Kumite (sparring)_____ Team Kata_______ Total amount of payment $ ______
Make Payments to: American Shotokan karate Academy
Mail all Pre-Registration with payments or payment receipt from paypal and Applications to:
American Shotokan Karate Academy
4700 Trimmier Rd. (Suite F) Killeen, Texas 76542
Amateur Athletic Waiver and Release of Liability
Amateur in consideration of being allowed to participate in the American Shotokan Karate Championship
and related events and activities, the undersigned:
1. Agrees that prior to participation, they, or if participant is a minor child, the parent(s) or guardian(s) will
inspect the facilities and equipment to be used and if they believe anything is unsafe, they will immediately
advise their coach or member of the event staff of such condition(s) and refuse to participate.
2. Acknowledge and fully understand that each participant will be engaging in activities that involve risk of
serious injury, including permanent disability, death, severe social and economic losses which might result
not only from their own actions, inaction or negligence but actions or negligence of others, the rules of fair
play, or the condition of the premises or of any equipment used. Further, that there may be other risks not
known to us or nor reasonably foreseeable at this time.
3. Assume all the foregoing risks and accept personal responsibility for the damages following such injury,
permanent disability or death.
4. Release, waive, discharge any covenant to sue the American Shotokan Karate Academy, Sensei Michael
J. Jackson, Camp Triumph, their respective administrators directors, coaches and other employees of the
organization, other participants, sponsoring agencies, sponsors, advertisers and if applicable,owners and
leasees of the premises used to conduct the event all of which hereinafter referred to as (re-lessees) from
any and all liability to each of the undersigned, his or her heirs and next of kin for an and all claims,
demands, losses or damages on account of injury including death or damage to property, caused or alleged
to be caused in whole or in part by the negligence of the releases or otherwise.The undersigned have read
the above waiver and releases, understand that they have given up all rights by signing it and sign it
voluntarily.
Contestant’s Signature Date
Parent or Guardian (if under 18) ________________________________________ Date___________
Name_________________________ Birthday_______(student's age_____Phone_____________
Address______________________________ City___________________State____ Zip___________
Dojo_________________ Phone ___________________Your E-mail______________________
Instructor_______________________ Style __________________________________
Time training
Kyu -Rank (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) Dan Rank Black Belt___________
Kata (forms)_____ Kumite (sparring)_____ Team Kata_______ Total amount of payment $ ______
Make Payments to: American Shotokan karate Academy
Mail all Pre-Registration with payments or payment receipt from paypal and Applications to:
American Shotokan Karate Academy
4700 Trimmier Rd. (Suite F) Killeen, Texas 76542
Amateur Athletic Waiver and Release of Liability
Amateur in consideration of being allowed to participate in the American Shotokan Karate Championship
and related events and activities, the undersigned:
1. Agrees that prior to participation, they, or if participant is a minor child, the parent(s) or guardian(s) will
inspect the facilities and equipment to be used and if they believe anything is unsafe, they will immediately
advise their coach or member of the event staff of such condition(s) and refuse to participate.
2. Acknowledge and fully understand that each participant will be engaging in activities that involve risk of
serious injury, including permanent disability, death, severe social and economic losses which might result
not only from their own actions, inaction or negligence but actions or negligence of others, the rules of fair
play, or the condition of the premises or of any equipment used. Further, that there may be other risks not
known to us or nor reasonably foreseeable at this time.
3. Assume all the foregoing risks and accept personal responsibility for the damages following such injury,
permanent disability or death.
4. Release, waive, discharge any covenant to sue the American Shotokan Karate Academy, Sensei Michael
J. Jackson, Camp Triumph, their respective administrators directors, coaches and other employees of the
organization, other participants, sponsoring agencies, sponsors, advertisers and if applicable,owners and
leasees of the premises used to conduct the event all of which hereinafter referred to as (re-lessees) from
any and all liability to each of the undersigned, his or her heirs and next of kin for an and all claims,
demands, losses or damages on account of injury including death or damage to property, caused or alleged
to be caused in whole or in part by the negligence of the releases or otherwise.The undersigned have read
the above waiver and releases, understand that they have given up all rights by signing it and sign it
voluntarily.
Contestant’s Signature Date
Parent or Guardian (if under 18) ________________________________________ Date___________
| 1-800-910-2380 |
| Registration $45.00 for Team Kata $45.00 for entire team, not each member of the team |