3 rd KUNG-FU-WUSHU STATE CHAMPIONSHIP 2017-2018

SUB JUNIOR, JUNIOR, SENIOR

Waiver of liabilities
Association / Club / School:-_____________________________________
Name of Participants:- _________________________________________
Date of Birth:- ___________________ Sex:- ______________________
Address:- ___________________________________________________
Ph.:- ____________ Mobile:- _______________ E-mail:- ___________________________________
Athlete Team Manager Coach
I am taking part in the following events,
Events / Patterns / Forms / Weapons
1) Snake Style 2) Monkey Style 3) Eagle Style 4) Tiger Style 5) Single Stick 6) Double Stick
7) Sword 8) Spare
SANDA (Fight) Kg: - _____________________ ( Please )
Sub Junior 31/12/1998 (under 14 years)
Junior 31/12/1995 to 31/12/1997 (under 17 years)
Senior - 01/03/1979 to 31/03/1995 (under 19 years)
I, _____________________________________________ the undersigned knowingly and
without duress, do voluntarily my entry to the 3rd Sub-Junior, Junior, Senior Kung-Fu-Wushu State
Championship in consideration Kung-Fu-Wushu Association of Maharashtra. I hereby assume all risk
of physical and mental injuries, disabilities and losses which may result from or in connection with
my participation in 3rd Sub-Junior, Junior, Senior Kung-Fu-Wushu State Championship is organized
by Kung-Fu-Wushu Association of Maharashtra, collectively refer as Organizing Committee action
for myself, heirs, personal officers, agents, representatives assignees. I do hereby release the
organizing committee. Its officers, agents, representative, volunteers and other members from all
claims, action,suits and controversies at law or in equity by reason of any matter, cause or thing
whatsoever that I may sustain as a result of or in connection with my participation in the 3rd Sub-
Junior, Junior, Senior Kung-Fu-Wushu State Championship. I fully understand that all medical
attention or treatment afforded to me by Kung-Fu-Wushu Association of Maharashtra its officers,
representative, volunteers and all other members will be the first aid only, and hereby release the
Kung-Fu-Wushu Association of Maharashtra its officers, representatives, volunteers and all other
related members from any liability for such aid, I understand it is my obligation to obtain medical
coverage.
I agree to abide by and follow the Rules established by the Kung-Fu-Wushu Association of
India and I understand that my protest must be conducted in accordance with the rules of
Arbitration.
I agree that my performance, attendance and participation at the 3rd Sub-Junior, Junior,
Senior Kung-Fu-Wushu State Championship may be filmed or otherwise recorded or released or
telecast live. 1 consent to use Kung-Fu-Wushu Association of Maharashtra, my name, address,
voices, poses, pictures and biographical data concerning full or part in any form of language, with or
without material, throughout the world, without limitation for television, radio, video, theatrical
medium picture or any other medium by any other devices now or hereafter devised and I do hereby
Waive any compensation in regard thereof as well as any future rights to the aforementioned.
I have read and fully undersigned the waiver listed above.
(Signature of Parent or Legal Guardian id required if applicable in under 18)

____________________ _______________________ _______________

Signature of Participant Signature of Parent / Guardian Date