2015 Australian Kung-Fu Wushu Championships · - Southern Style (Jow Gar, Hung Gar, Choy Li Fut, White Crane, Wing Chun, Bak Mei, Ging Mo Kune ... body piercing, earrings or rings

2015 Australian Kung-Fu WushuChampionships

3rd May 2015

Ryde Community and Sports CenterKent RoadRyde, NSW

Conducted byKung Fu Wushu New South Wales

KWNSW officially recognised by the Kung Fu Wushu Australia as the peak governing body forKung Fu (Wushu) in New South Wales

KWA officially recognised by the Australian Sports Commission as the peak governing body forKung Fu (Wushu) in Australia

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TABLE OF CONTENTS

GENERAL INFORMATION......................................................................................................1

ROUTINE COMPETITION RULES AND REGULATION .........................................................3

SPARRING COMPETITION RULES AND REGULATION.......................................................7

APPLICATION AND ASSESSMENT FORM FOR DEGREE OF DIFFICULTY OF

OPTIONAL TAOLU................................................................................................................11

CERTIFICATE OF FITNESS (SANDA FULL CONTACT) .....................................................12

SEROLOGY REPORT (SANDA FULL CONTACT) ...............................................................17

APPLICATION INDEMNIFICATION WAIVER FORM TO PARTICIPATE.............................18

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2015 Australian Kung-Fu Wushu Championships

GENERAL INFORMATION

1. Championship DateSunday 3

rdMay 2015 9:00 am – 5:00pm (Registration 8:30am)

The Championship Organising Committee reserves the right to make changes to the programmewhich are deemed fit.

2. Championship VenueRyde Community and Sports CenterKent RoadRyde, NSW

3. Competitors Qualification For Entry(a) Only members of Kung Fu Wushu Australia’s State Associations are eligible to participate in

the Championships.(b) Competitors must submit the required documentation and pay the designated fees (refer to

Championship Fees and Registration)

4. Registration(a) Internet Sign Up System will be adopted. The competitors shall fill out online Entry Forms and

make payment via the Internet.

(b) Website for Internet Registration System:http://www.2015nationals.eventbrite.com.au

(c) Closing date for internet registration is Friday, April 3 2015.

(d) Competitors must also submit the completed and signed Waiver Form by the registrationclosing date and email to [email protected]

(e) Any competitor who has registered online and also supplied the required documentations bythe required dates will be entered into the Championships.

(f) No changes or additional entries will be accepted after the deadline.

(g) Refunds only issued in special cases and will be subject to administration costs as decided bythe Championship Organising Committee.

(h) All competitors are required to check-in on the day of their event. Any competitor who does notcheck-in by within 30 minutes of their event may be forfeited to compete and entry monies willbe retained by KWA:

5. Australian National Wushu Team Selection(a) The following wushu taolu and wushu sanda events will be used to select the 2015 - 2016

Australian National Wushu Team: Youth / Adult Optional Taolu with Nandu Youth / Adult Traditional Taolu (Xingyiquan, Baguazhang, Dadao or Shuangjian only) Youth / Adult Compulsory Taolu (Hand Form only and must be the 3

rdInternational

Competition Routine) Adult Sanda Events

(b) Competitors wanting to be considered for the Australian National Wushu Team must submit theApplication for Australian National Wushu Team Selection. Information on how to register canbe found on www.kungfuwushuaustralia.com

(c) Applicants must fulfil the eligibility requirements stated in the Application for Australian NationalWushu Team Selection to be considered for the Australian National Wushu Team.

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6. Championship Fees

Australian DollarsKWA Members

First individual routine or sparring event $45 per personSecond individual routine or sparring event $15 per personDuel routine event $15 per personGroup routine event $10 per person

7. Travel and accommodationAll travelling expenses (eg. air fare and transportation), accommodation, tours and sightseeing areat own expense.

8. Anti-Doping PolicyAll competitors must comply with the KWA Anti-Doping Policy which can be viewed atwww.kungfuwushuaustralia.com therefore agreeing to any random drug testing as requested bythe Australian Sports Drug Agency.

9. EnquiriesFor further information and enquires regarding the Championship, please contact:

General Enquiries:Email: [email protected]

Unacceptable Behaviour Disciplinary ProceduresThe KWA has a zero tolerance policy towards unsportsmanlike, disruptive andunprofessional behaviour.

Competitors will be immediately disqualified from this event for conduct which the ChiefReferee of that event considers to be unsportsmanlike, disruptive or unprofessional. Thisconduct may include, but not be limited to, cheating, dishonesty, failing to comply with thereasonable directions of a competition official, jeering, interference with the activities ofcompetition officials, publicly criticising judges' decisions outside the appeals process laiddown in this documents and any other form of behaviour likely to bring the sport intodisrepute.

In the event of a complaint about the conduct of a competitor, the Chief Referee must benotified ASAP of the incident. It is the Chief Referee's responsibility to advise thecompetitor, on the spot, that he/she will be disqualified.

Other persons may be expelled from the event for conduct which the Chief Referee findsunacceptable.

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ROUTINE COMPETITION RULES AND REGULATION

10. Championship Events and Age Divisions Age Divisions

- Child 7 to 12 years old- Junior 13 to 15 years old- Youth 16 to 18 years old- Adult 19 to 45 years old- Senior 46 years and above

Note: Age is based on the competitor’s birthday during the championship year.

Kung Fu EventsBare Hand:- Northern Style (Northern Shaolin, Northern Praying Mantis, etc)- Southern Style (Jow Gar, Hung Gar, Choy Li Fut, White Crane, Wing Chun, Bak Mei,

Ging Mo Kune, etc)- Other Style (Xing Yi Quan, Ba Gua Zhang, Ba Ji Quan, etc)

Weapon:- Long Weapon- Short Weapon- Other Weapon (Flexible, Double Weapons, etc)

Wushu Taolu EventsBare Hand: Nandu Events (Youth and Adult Age Group only)- Optional Changquan- Optional Nanquan- Optional Taijiquan

Non-Nandu Events- Changquan- Nanquan- Taijiquan- Baguazang- Xingyiquan

Weapon: Nandu Events (Youth and Adult Age Group only)- Optional Daoshu- Optional Jianshu- Optional Gunshu- Optional Qiangshu- Optional Nandao- Optional Taijijian

Non-Nandu Events- Daoshu- Jianshu- Gunshu- Qiangshu- Nandao- Taijijian- Dadao- Shuangjian

Tai Chi EventsBare Hand: Compulsory Routines

- Yang Style Taijiquan- Chen Style Taijiquan- 36 Step Taijiquan (3rd Set Competition Routine of Taijiquan)

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New Routines- 24 Step Taijiquan- 42 Step Taijiquan- Yang Style Competition Routine- Chen Style Competition Routine

Traditional Routines- Yang Style- Chen Style- Wu Style- Sun Style- Wu (Hao) Style- Other Style

Weapon: Compulsory Routines

- Yang Style Taijijian- Chen Style Taijijian- 39 Step Taijijian (3rd Set Competition Routine of Taijijian)

New Routines- 32 Step Taijijian- 42 Step Taijijian

Traditional Routines- Yang Style Sword- Chen Style Sword- Wu Style Sword- Sun Style Sword- Wu (Hao) Style Sword- Other Style Sword- Other Weapon (Fan, Broadsword, etc)

Duel Events- Choreographed sparring sets of Bare Hand to Bare Hand, Weapon to Weapon or Bare

Hand to Weapon

Note: Championship Organising Committee has the power to merge any division or eventsif insufficient number of competitors for any division or events occurs.

A photocopy of your current Prohibited Weapon License must accompany yourChampionship Entry Form if your events involve any weapons prohibited in NewSouth Wales. You must also bring your license on the day of the Championship. Formore information on what weapons are prohibited in NSW, please go to:

https://www.police.nsw.gov.au/__data/assets/pdf_file/0018/133191/Prohibited_Weapons_Schedule1_April_2012.pdf

11. Participation Methods Each routine competitor may enter at most:

- one bare-hand event- one weapon event- one duel event- one group eventfor a maximum of 4 (four) events

Duel event is limited to 2-3 persons. Male and female mixed teams are not allowed.

In group events, teams shall consist of no less than 6 persons and no more than 10. Maleand female competitors can be mixed. Each participating organisation may only enter onegroup team.

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12. Relevant Rules(a) Routine Events – Kung Fu, Tai Chi, Duel and Group

The Kung Fu and Tai Chi events shall be individual competition.

The competition rules for Kung Fu, Tai Chi, Duel and Group will be based on the “Rules forInternationa Taolu Competition” endorsed by IWUF in 1999. These rules can be obtained atwww.kungfuwushuaustralia.com

Music should be accompanied to the group routine. CD shall be brought by the participatingteams. No lyrics are allowed, otherwise 0.20 points will be deducted by the head judge. Thehead judge will deduct 0.20 points if the group performs without music.

The power of interpretation of the Rules rests solely with the Chief Judge.

(b) Routine Events – Wushu The competition shall be individual competition.

The competition rules for Wushu will be based on the “Rules for International TaoluCompetition” endorsed by IWUF in 2005. These rules can be obtained atwww.kungfuwushuaustralia.com

Optional Taolu with Nandu- The Scoring Criteria for Events with Specific Requirements for Degree of Difficulty will

be implemented.

- Competitors are required to submit the Registration Form for Movements with Degree ofDifficulty by for all of their events and emailed to [email protected]

Non-nandu taolu events- The Scoring Criteria for Events without Specific Requirements for Degree of Difficulty

will be implemented.

Music must be accompanied to Optional Taijiquan and Optional Taijijian. Lyrics are notpermitted. 0.2 point will be deducted if there is no music accompanied to the said routines.


13. Time Requirements for Routine Events(a) Kung Fu Events:

Bare hand and Weapon routines: Not less than 40 seconds and not more than 1 minuteand 30 seconds.

(b) Wushu Events Changquan, Nanquan and Weapon routines:

- Adult and Youth Age Group: Not less than 1 minute and 20 seconds and not more than1 minute 30 seconds.

- Child, Junior and Senior Age Group: No time limit.

Taijiquan and Taijijian routines:- Not less than 3 minutes and not more than 4 minutes. And NO warning bell will be

given.

Xingyiquan, Baguazhang, Dadao and Shuangjian routines:- Not less than 1 minute and not more than 2 minutes.

(c) Tai Chi Events All new routines and traditional hand routines: 5 to 6 minutes. Warning bell given at 5:30. All new routines and traditional weapon routines: 3 to 4 minutes. Warning bell given at 3:30. Group routines: 4:30 to 5 minutes. Warning bell given at 4:30.

(d) Duel Events:Not less than 40 seconds and not longer than 1 minute and 30 seconds.

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(e) Group Events Not less than 2 minutes and not longer than 5 minutes.

14. Competitors Costume, Uniform, Foot Wear & Equipment(a) Wushu Taolu events

Competitors must wear wushu taolu competition costume in compliance with the “Rules forInternational Taolu Competition” as endorsed by IWUF in 2005 to participate in thecompetition.

Martial arts style athletic or any rubber-soled sports shoes/sneakers must be worn(performance with bare feet is not allowed).

Competitors shall bring their own competition weapon for their own respective events.

Jewellery, including watches may not be worn. Nails must be clipped short and metal hairclips are also not to be worn. No heavy metal, body piercing, earrings or rings. If a ringcannot be removed, it must be taped.

Note: Failure to comply with these rules will result in disqualification from their event.

(b) All other routine events Kung Fu Costume: traditional kung-fu costume, or official Academy / Club / School martial

arts uniform.

Tai Chi Costume: traditional tai chi costume or official Academy / Club / School martialarts uniform.

If the competitor has no costume or uniform, a plain T-shirt, track pants and a sash must beworn.

Martial arts style athletic or any rubber-soled sports shoes/sneakers must be worn(performance with bare feet is not allowed).

Competitors shall bring their own competition weapon for their own respective events.

Jewellery, including watches may not be worn. Nails must be clipped short and metal hairclips are also not to be worn. No heavy metal, body piercing, earrings or rings. If a ringcannot be removed, it must be taped.


15. Placing and AwardsThe top three places for each event will be awarded as follows:

1st Place Gold Medal2nd Place Silver Medal3rd Place Bronze Medal

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SPARRING COMPETITION RULES AND REGULATION

1. Championship Events and Age Divisions

(a) Controlled Contact Sparring Events Age Divisions

- 7 – 8 years old- 9 – 10 years old- 11 – 12 years old- 13 – 15 years old- 16 – 18 years old- 19 – 35 years old- 36 to 55 years old


Weight Classes:- Men and Women: below (kg): 36, 40, 44, 48, 52, 56, 60, 65, 70, 75, 80, 85, 90,

over 90kg

Championship Organising Committee has the power to merge any divisions ifinsufficient number of competitors for any divisions occurs.

(b) Sanda Full Contact Sparring Events Age Divisions

- Youth 16 to 18 years old- Adult 19 to 35 years old


Weight Classes:- Men and Women: below (kg): 36, 40, 44, 48, 52, 56, 60, 65, 70, 75, 80, 85, 90,

over 90kg

Note: Championship Organising Committee has the power to merge any 2 neighbouringdivision or events if insufficient number of competitors for any division or eventsoccurs.

2. Participation Methods

Each competitor may register and compete in both controlled contact sparring and sandafull contact sparring events.

Each competitor may only enter in 1 (one) weight category.

3. Relevant Rules

(a) Controlled Contact Sparring Events All techniques must be controlled contact.

The elimination system will be adopted. If the number of competitors in a weight category isonly 3 (three), a round robin will be adopted.

The competition will be based on the “KWA Controlled Contact Sparring Rules”. Theserules can be obtained at www.kungfuwushaustralia.com

Each bout will be one (1) round. The competition time for each round will be two (2)minutes for 19 years and above and one (1) minute thirty (30) seconds for 18 years andunder.

A competitor exiting / falling out of the arena twice in a round will lose the round.


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Legal Target Areas- Torso above the waist including front and side.

- Thighs, inside and outside of thigh area and the leg below the knee.

Prohibited Areas of Attack- Any part of the head.

- Any part of the neck;

- The groin.

- The back (spine).

- The knees, elbows and other joints.

Legal Techniques:

7 – 8yrs

9 – 10yrs

11 – 12yrs

13 – 15yrs

16 – 18yrs

19 – 35yrs

35 – 45yrs

Clinching (max two seconds only)

Sweeps and takedowns

Throws that will not cause injury

Punches to the body

Kicks to the body and legs

Kicks to the inside and outside of thigh area

Prohibited Methods:- Striking to the head whether making contact or as a feint.

- Head butt, forearm, elbow and knee strikes or arm locks and similar joint-lockingtechniques.

- Throws that could result in a head, neck or spine injury or throws which cause acompetitor to land awkwardly on the head, neck, spine, shoulder, knee or joints orthrows with a falling height from above shoulder level.

- Intentionally smashing or pressing him down.

- Hitting the opponent’s head by any means when he is already down.

- Choke or strangling techniques.

- Grappling or wrestling on the mats.

- Grasping an opponent with one or two hands and striking with the other hand orkicking.

- Pushing the opponent for more than 1 metre or off the arena.

- All prohibited techniques which are deliberately intended to injure the opponent ratherthan to score points are whether on target or not. The consideration will be judged onwhat would have happened if the opponent was struck by the technique.

(b) Sanda Full Contact Sparring Events The competition shall be Full Contact.

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The elimination system will be adopted. If the number of competitors in a weight category isonly 3 (three), a round robin will be adopted.

The competition will be based on the “KWA Sanda Sparring Rules”. These rules can beobtained at www.kungfuwushaustralia.com

The competition time for each round shall be 2 minutes for adults and 1 minute 30 secondsfor youths. Each bout will be the best of three (3) rounds.

A competitor exiting / falling out of the arena twice in a round will lose the round.


Legal Target Areas- Any part of the head except the back of the head.

- Torso above the waist including front and side but excluding the back.

- Thighs, inside and outside of thigh area and the leg below the knee.

Prohibited Areas of Attack- The back of the head.

- Any part of the neck.

- The groin.

- The back (spine).

- The knees, elbows and other joints.

Legal Techniques:- Hand, leg techniques, takedowns and sweeps which are not listed as a prohibited

technique may be used to attack any legal target area.

Prohibited Methods:- For youth sanda events, kicks to the head as well as successive/continuous punches

to the head are not permitted.

- Head butt, forearm, elbow and knee strikes or by arm locks and similar joint-lockingtechniques.

- Takedowns by sweeps and throws that could result in a head, neck or spine injury orthrows which cause a competitor to land awkwardly on the head, neck, spine,shoulder, knee or joints or throws with a falling height from above shoulder level.

- Intentionally smashing or pressing him down.

- Hitting the opponent’s head by any means when he is already down.

- Choke or strangling techniques.

- Grappling or wrestling on the mats.

4. Competitors Costume, Uniform, Foot Wear & Equipment

(a) Controlled Contact Sparring Events Competitors must wear and bring their own gloves, cotton shin protectors, cotton instep

protectors and mouth guards. Gloves will be either red or black.

The weight of the gloves will be 230 grams (8 oz) for men 65kg category & under, womenof all weight categories and juniors (18 years and under) of all weight categories. Theweight of the gloves will be 280 grams (10 oz) for men 70kg category & above.

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Male competitors must wear and bring their own groin guard. All groin guards must be wornunder the uniform pants. Groin guards are optional for female competitors.

Adult female competitors must wear and bring their own approved chest protector.

Each competitor must wear his/her traditional martial arts school uniform consisting of shirtor singlet and long pants or shorts, pertaining to his or her school and in good condition. Nostreet clothes are permitted. The head judge will have the final say as to whether anyclothing is or is not acceptable in competitions.


(b) Sanda Full Contact Sparring Events Competitors shall wear costumes and protective gears in compliance with the “Rules for

International Sanshou Competition” as endorsed by IWUF in 2005 to participate in thecompetition.

Each competitor must bring their own two (2) sets of costumes: one set of black and oneset of red costumes.

Gloves and protective gear will be provided by the Organizing Committee except for gum-shield and jockstrap which will be provided by the competitors themselves.


5. Weighing-inControlled Contact Sparring Events

The weighing-in will take place on the day of the Championships at the Championshipvenue at 8am.

Sanda Full Contact Sparring Events The weighing-in will take place on the day of the Championships at the Championship

venue at 830am.

Competitors are required to submit a KWA Certificate of Fitness and Serology Report.These must be issued within 30 days before the Championships and signed by a qualifieddoctor. This will be submitted during weigh-in.

6. Placing and AwardsAll Sparring Events

The top three places for each event will be awarded as follows:

1st Place Gold Medal2nd Place Silver Medal3

rdEqual Place Bronze Medal(s)

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APPLICATION AND ASSESSMENT FORM FOR DEGREE OF DIFFICULTY OF OPTIONAL TAOLU

Association: ________________________________________________________________

Name: _____________________________Surname:_______________________ Male/Female

Movement Code

Degree of difficulty for movements, and connections Event:______________________

1STSEGMENT

2NDSEGMENT

3RDSEGMENT

4THSEGMENT

TOTAL

VALUE MovementsTransitions

Signature of Coach Contact Info

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Certificate of Fitness (Sanda Full Contact)

PART ONE – To be completed by the examining medical practitioner

Full Name of the Sanda Contestant ________________________________________________________

Address _____________________________________________________________________________

_______________________________________________________________Postcode _____________

Date of Birth _________________________________ Sex _____________________________________

I certify that this person is in good health to participate in full contact martial arts contests.

Signed _____________________________________ Print Name _______________________________Medical Practitioner Medical Practitioner

Provider Number _____________________________

Date _______________________________________

Medical practitioner’s stamp

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PART TWO – Medical and Competition History

Division 1 – Personal Details and Competition History(To be completed by the contestant)

Name of Sanda Contestant _________________________________________ Examination Date________________

Contestant’s address ______________________________________________ Date of birth ____________________

Contestant’s telephone number ______________________________________ Sex......M / F (circle one)

1. Career competition history:

Career Results Wins Losses Draws

Amateur

Professional

2. Have you suffered any injury while competing? Yes / No (circle one)

3. Have you had any headaches, vomiting or problems with speech or vision after a contest? Yes / No (circle one)

Division 2 – Medical History(To be completed by the medical practitioner)

Yes

No

Yes

No

Yes

No

1. Have you at presentany:a. illnessb. disability

10. a. Shortness of breath 20. a. Nervous troubleb. Severe depressionc. Mental illnessd. Attempted suicide

2. Are you now receivingmedicine, drugs, orother treatment

11. a. Pneumoniab. Bronchitis or pleurisy

21. a. Kidney diseaseb. Bladder diseasec. Pain passing urined. Blood in your urine

3. Has an accident orillness kept you off workfor more than one week

12. a. Coughing bloodb. Coughing up phlegm

22. Frequent indigestion

4. Have you ever had anyoperations

13. Tuberculosis 23. a. Ulcer of stomachb. Ulcer of duodenum

5. Have you ever been apatient in any hospital:a. Medicalb. Other

14. a. Asthmab. Other lung disease

24. a. Gall bladder troubleb. Gall stones

Have you ever had or are you nowsuffering from any of the following?

15. a. Deafnessb. Tinnitus

25. Sugar diabetes

6. a. Rheumatic feverb. Heart disease

16. a. Visual problemsb. Do you wear glassesor contact lens

26. a. Hepatitis or otherjaundiceb. Liver disease

7. Palpitations or poundingheart

17. a. Fainting attacksb. Blackouts

27. a. Ruptureb. Herniac. Swollen or painfultesticles

8. High or low bloodpressure

18. a. Fits or convulsionsb. Epilepsyc. Giddiness

28. a. Any skin troubleb. Tendency to bruise orbleed easily

9. Swollen or painful joints(other than throughinjury)

19. a. Severe headachesb. Migraines

29. a. Concussionb. Severe head injuryc. Loss ofconsciousness

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Yes

No

Yes

No

Yes

No

30. Knee injuryAnkle injuryBack injuryOther joint injury ordislocation

32. Paralysis (includingpolio)

34. (Females)Are you pregnant?

31. Fractured bonesChipped bones

33. Any other injury, illnessor disability

Medical Practitioner’s Notes on History (A ‘Yes” answer to any question requires the medical practitioner to state thequestion number and comment here)

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

35. Over the past five (5) years has the contestant, either occasionally or regularly, taken any stimulants, sedatives,medications or drugs by mouth or by injection? Yes / No (circle one)

If ‘Yes”, provide details and, if prescribed by a doctor, include the relevant particulars in question 36 below.

36. Over the past five (5) years has the contestant had any medical examination, advice, treatment or been in hospital?

Yes / No (circle one)

If ‘Yes”, provide particulars of each instance (including x-ray, electrocardiogram or other special tests) in the table below.

Date Name and address of doctor and/orhospital

Reason (If illness or injury, give duration and dateof recovery)

37. Details of photographic identification presented to the medical practitioner, eg driver’s licence or passport:

_____________________________________________________________________________________________

Contestant’s Declaration and Release of Medical Information Authorisation

I declare that the information in the Certificate of Fitness true and complete to the best of my knowledge and belief.

Contestant’s name (print) _________________________Signature______________________ Date _____________

I have completed the above medical history and have witnessed the contestant’s signature.

Signature of medical practitioner _________________________________ Date ___________________________

Print Name ___________________________________________

THIS MEDICAL FORM AND THE INFORMATION HEREIN IS TO REMAIN CONFIDENTIAL ANDSECURELY STORED BY THE PROMOTER FOR A PERIOD OF 12 MONTHS FROM THE DATEOF SIGNING.

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PART THREE – Record of Medical Examination

Medical Examination(Medical practitioner to complete) Tick the appropriate column. If not examined, insert ‘NE’ in the Normal column

Physical Examination Normal Abnormal Physical Examination Normal Abnormal

1. a. Head, face, scalpb. Neck R.O.M.

15.. Abdomen (include hernialorifices)

2. a. Nose deformityb. Nose airway

16. Endocrine system

3. a. Mouth, throatb. Speech

17. External genitalia

4. a. Teeth, gumsb. Dentures Yes / No

18. a. Feetb. Limbs R.O.M.c. Gait

5. a. Ears – generalb. Ears - hearing

19. A. Spineb. Trunk R.O.M.c. Posture (standing)

6. Tympanic membranes 20. a. Nervous systemb. Cranial nerves

7. Eustachian tubes 21. a. Cerebellum functionb. Body balance/coordination

8. Eyes – general 22. a. Muscle toneb. Muscle strengthc. Sensation

9. a. Visual fieldsb. Eye gaze

23. Reflexes

10. Eye movement 24. Skin

11. Ophthalmoscopicexamination

25. Lymphatic systemLymph glands in neckaxillae or inguinal

12. Chest, lungs 26. Emotional stability

13. Heart (if ECH performed,note result in section &enclose F MED 53)

27. Other

14. Vascular system (includeveins)

28. Identifying marks

29. Frame: Large Medium Small 30. Height: (cm)

31. Chest: (cm) Exp Ins 32. Waist (cm)

33. Urinalysis: Albumin Sugar 34. Weight: (kg)

35. Blood Pressure: Systolic Diastolic 36. Eyes – colour

37. Distant vision: R6 Corr 6 L6 to 6

Near vision: Normal / Abnormal

38 Has a MRI Scan been conducted? Yes / No Is the MRI satisfactory Yes / No

Any further testing required? Yes / No Please attach a copy of the radiologist’s report.

39. Medical Practitioner’s Notes on Medical Examination (provide details of any abnormality noted and enter therelevant question number before each comment)

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

40. Is any further testing required? Yes / No (circle one)

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Neuro/Psychological Examination

Yes No

41. Is there any evidence of a change in character?

42. Has the contestant a good memory for recent events and, in particular, recent contests?

43. Does the contestant follow conversation with attention and intelligence?

44. Is there any evidence of a tendency to violence outside the competitive arena?

45. Medical Practitioner’s Notes on Neuro/Psychological Examination (state whether further assessment is required)

_____________________________________________________________________________________________

_____________________________________________________________________________________________

46. Particulars of any Disabilities

_____________________________________________________________________________________________

_____________________________________________________________________________________________

47. Medical Practitioner’s Summary

Name of examined contestant______________________________________________________________________

Do you consider the contestant to be in good health to participate as a contestant in full contact martial arts contests?

Yes No Further Assessment Required (circle one)Any comments:

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Signature of medical practitioner_______________________________________________ Date ________________

Name of medical practitioner (please print)________________________________ Telephone number ____________

Address of practice ______________________________________________________________________________


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Serology Report (Sanda Full Contact)

Medical Practitioners Report

I certify that:

Name of Sanda contestant __________________________________________________________

Address of Sanda contestant ________________________________________________________

_______________________________________________________________________________

Attended for tests for H.I.V., Hepatitis B Antigen and Hepatitis C on ______________________________(insert date)

The test results:

i. H.I.V. Negative Other_________________________________________

ii. Hepatitis B Antigen Negative or immune Other____________________________

iii. Hepatitis C Negative Other_________________________________________

Comment on results not negative or immune

____________________________________________________________________________________

____________________________________________________________________________________

Medical Practitioners Signature _________________________________________________________

Date ________________________

Please Print:

Name of medical practitioner ______________________________Telephone No.___________________

Practice Address_______________________________________________________________________

____________________________________________________________________________________


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APPLICATION INDEMNIFICATION WAIVER FORM TO PARTICIPATE

IN THE 2015 AUSTRALIAN KUNG-FU WUSHU CHAMPIONSHIPS

3rd

May 2015

Ryde Community and Sports Center

PARTICIPATING IN A MARTIAL ARTS TOURNAMENT IS DANGEROUS AND CAN CAUSE SERIOUSINJURIES

___________________________________________________________________________

1. COMPETITIOR'S DETAILS:

Given Names: ……………………………………………………….…………………...

Last Name: …………………………………………………………………………….

Date of Birth: .……...........…...

Address: ……………………………………………………………….………………...

State: ……...................Postcode: ....................... Country: ……………………………..

Ph (home).......................................Ph (work)…………………....………………...

Mobile / Phone: …………………………………………………………………………

Email: ………………………………………………………………………………….

2. WAIVER AND INDEMNITYApplicant for him/herself, his/her executors, administrators, dependents and other personalrepresentatives, hereby absolves and indemnifies the providers and all their servants, agents,employees and other students or persons under the providers control (the "indemnified")from all liability howsoever arising for injury or damage (including but not limited to theApplicants' person, whether fatal or otherwise, property and personal belongings) howevercaused including by the negligence of the indemnified, arising out of or participating inMartial Arts competition or in connection with Martial Arts or in any way caused by, or arising outof, any activity carried on by the indemnified.

I, the Applicant, have been advised and understand that the practice of martial arts is potentiallydangerous.

I, the Applicant, agree to occupy and use the premises of the Kung Fu Wushu Australia Ltd(KWA) / Kung Fu Wushu NSW (KWNSW) at risk to myself and release to full extent permittedby law The KWA / KWNSW, and its agents, servants, contractors and employees from all claimsand demands of every kind in of or resulting from any accident or damage to property or injuryor death to myself while participating in a martial arts competition/event/contest conducted bythe KWA / KWNSW.

3. MEDICAL DECLARATIONI certify and acknowledge that I have NO physical disabilities or injuries that would impair myparticipation in any such competition or tournament and that I further certify that I do not sufferfrom any illness or blood related virus that may be transmitted to any other competitor, official orspectator.

I declare that I have not been rendered semi or fully unconscious within the past four weeksfrom today’ date, and if prior to the event that I am rendered semi or fully unconscious I willnotify the organiser and withdraw my registration.

4. MEDICAL TREATMENTI consent to any emergency treatment that may be necessary as a result of any injury that I maysustain during the course of the tournament. I fully understand that any medical treatmentprovided to me as a response to injury, will be of FIRST AID type only and I am duly reasonableto arrange any transport at my own expense to a suitable medical centre or hospital if it isdeemed the injury requires further treatment or in the event I have been rendered unconscious

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or unable I authorise for an ambulance to be called on my behalf to transport me to such afacility.

5. MARTIAL ARTS DONE AT APPLICANT'S OWN RISKAny person participating at any martial arts contest/event/competition organised by the KWA /KWNSW are only allowed to do so on the distinct understanding that they do so entirely at theirown risk.

6. ACCEPTANCE OF COMPETITION SURFACEI accept that the competition surface will not be of the same type and construction as thoseused in International events.

7. PERSONAL PROPERTYI accept that the neither the KWA / KWNSW nor its agents or employees shall be responsiblefor any loss or damage to such personal property or equipment that I may bring to thecompetition/event/contest.

8. USE OF IMAGEI hereby grant my consent for any photographic or video recording of my performance to beused by the KWA / KWNSW or any entity that the KWA / KWNSW so authorises. I agree that Iwill make waive entitlement to any payment or compensation for the use of my image and/orperformance.

9. RULES AND REGULATIONSI hereby acknowledge that my Instructor/Coach has explained in full the rules of thecompetition and I undertake to abide by the rules, regulations and resolutions of the competitionorganisers as they may decide during the course of the competition.

10. STATEMENT OF UNDERSTANDINGI, the Applicant have read, or have had read to me the above conditions and havingunderstood the same, I consent to the activities proposed.

Signed (Applicant) ..................................................................................... Date ..................................

[This application must be signed by a guardian if the Applicant is under the age of 18.]

in the presence of (signature of witness)

Name: ....................................................... Signed................................... Date ...............................

SCHEDULE 1

In addition to the Kung Fu Wushu NSW Inc and Kung Fu Wushu Australia Limited., the providers inrespect of this agreement include:

(a) All State and territory branches of the KWA

(b) All KWA staff, officials and volunteers, including but not limited to:

Walt Missingham

David Crook

Frederic Ong

(c) All KWNSW staff, officials and volunteers, including but not limited to:

Alice Dong

William Chow

Documents

2015 Australian Kung-Fu Wushu Championships · - Southern Style (Jow Gar, Hung Gar, Choy Li Fut, White Crane, Wing Chun, Bak Mei, Ging Mo Kune ... body piercing, earrings or rings