MACHADO STATE CHAMPIONSHIPS 2008 WAIVER

PLEASE READ CAREFULLY THIS DOCUMENT AFFECTS YOUR LEGAL RIGHTS.

NAME___________________________________________D.O.B___/___/___

ADDRESS______________________________________________________

_________________________________POSTCODE___________________

PHONE__________________________MOBILE________________________

AFFILIATE ACADEMY_____________________________________________

I, do hereby submit my application to participate in the 2008 Machado State Championships held at Lange’s Martial Arts Centre, Pittwater Road, North Manly, on the 17th May 2008. I hereby assume full responsibility and liability for all damages, injuries and losses that I may incur while participating in or watching the tournament

I realise that serious injury in martial arts tournaments such as the one I am hereby entering; and that even death is a very real possibility. I also realise that if I am injured, I might be disfigured, disabled and or rendered unable to work again. I realise that regardless of how these consequences may occur - whether it be the result of an opponents actions, the action on inaction of a referee, the condition of the mats used, the conduct of a non-participant or any other reason - By entering into this agreement I accept the risk of entering and being present in the tournament and give up and waive all claims I or anyone acting on my behalf or through me might have against Lange’s Martial Arts Centre, Anthony Lange, the promoters, operators, sponsors, officials, referees, participants, non-participants, and representatives for any injury regardless of its nature, effect or affect on me as a result of my participation and or presence at the tournament.

I authorise whatever medical personnel, that may be present at the tournament to take any action necessary, should I become injured.

I further understand that tickets will be sold to spectators to watch the tournament; that news media and others may cover the tournament and that it may also be video taped or otherwise shown to audiences around the world. I hereby consent to having my likeness shown, publicized, commented/reported on; and 1 do not expect to, and in fact waive any compensation I might otherwise be entitled to as a result thereof.

I represent that I am in good health; that I am not presently, nor will I participate while under the influence of any drug medication; that no one affiliated with this tournament has encouraged me to enter or made any representations regarding my fitness or ability to participate; that I have read and understood every provision of this release; and that I am legally competent and freely enter into this waiver, release and assumption of risk agreement.

SIGNED___________________________SIGNED_________________________

Guardian signature if participant is under 18 years of age

DATE__/___/___ DATE____/___/___

Lange's Martial Arts Centre 7/380 Pittwater Rd North Manly 2100 ph: 02 9939 3706 Info: albjj@bigpond.com