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United States Kyokushin Open XIII Application – All Ages
Event Date: May 2nd, 2015 - Competition Starts at 9:00 a.m.
Location: Grand Summit Resort Hotel at Sunday River Resort Bethel, Maine
Entry Fees
 Pre-registration deadline: April 24th, 2015. *Add $15 after April 24th*
 Events and Fees: $50.00 for Semi Contact, Weapons Kata & Breaking (1 or all). $60.00 for Full Contact
 All entry fees are non-refundable.
 Make check or money order (US funds only) payable to: Maine Kyokushin Karate
 Mail to: Maine Kyokushin Karate 29 Main Street Suite 5 Norway, Maine 04268
Name: ______________________________
Date of Birth___/___/___
Address: __________________________________________
Phone # (
) ____________
Age____
Instructor:____________________________
School Name: ______________________
School Phone #(
)________________
Rank / Kyu_______ Yrs. Experience_________ Height__________ Weight___________Sex ____
Conditions of registration:
I, the undersigned, being at least 18 years of age, do hereby voluntarily submit my application for participation as a competitor in the
United States Kyokushin Open XIII Tournament held on May 2nd, 2015 in Newry Maine and do hereby assume full responsibility for
any damages, injuries or losses, including death that I may sustain or incur while attending or participating in the aforementioned
event, and do hereby waive any or all claims against Grand Summit Resort Hotel, Sunday River Resort, Martin R. Petrovich, Maine
Kyokushin Karate and the United States Kyokushin Open, its’ promoters, operators and/or sponsors of said event, individually or
otherwise, and specifically covenant to bring suit to the individuals or organizations mentioned above, fully recognizing that this
covenant is part consideration for my approval to compete, and upon which they have retired in accepting the above application. I
further understand, and am fully aware of the inherent risks of sustaining injury during the competition or in the preparation thereof
and that I completely assume all risks and liabilities thereto. I fully understand that any medical treatment provided to me as a
response to injury, will be of the First Aide type only.
(X)_________________________________________________________________
Applicant’s signature or Parent or Guardian (if under 18)
Directions for Kata, Weapons, Semi-Contact
and Weapons:
Please check all applicable divisions in the proper
age group
Age
Kata
Weapons
Semi-Contact
Breaking
3-5
Kata, Weapons & Semi-Contact
6-7
8-10 11-12 13-14 15-17
x
Full Contact:


Full Contact is Open Division and is
based on weight.
Please check appropriate weight division
only.
Note: Tournament director reserves the right to
combine or further divide divisions based on
participation
Date_______________
x
x
x
Rank Division
x
Beginner (10th-7th Kyu)
Intermediate (6th-3rd Kyu)
Advanced (2nd Kyu & above)
Women’s Full Contact
Lightweight: up to 135lbs
Heavyweight: 136 & above
Men’s Full Contact
Lightweight: up to 159lbs
Middleweight: 160-179lbs
Heavyweight: 180 & up
x
18-39
40+