Please ensure that you have ticked only the boxes relevant to

*14 - 17 yrs Black Belts MUST enter Junior Open Division**18 - 34 yrs Black Belts MUST enter Open Division

AGE GROUPS KATA KUMITE

Up to 7 yr Incl. Male & Female8 to 9 yr Incl. Male & Female10 to 11 yr Incl. Male10 to 11 yr Incl. Female12 to 13 yr Incl. Male12 to 13 yr Incl. Female14 to 15 yr Incl. Male14 to 15 yr Incl. Female16 to 17 yr Incl. Male16 to 17 yr Incl. FemaleJnr Black Belt Open Male (14 - 17 yrs)*Jnr Black Belt Open Female (14 - 17 yrs)*18 to 34 yr Incl. Male (up to 1st Kyu)18 to 34 yr Incl. Female (up to 1st Kyu)Open Black Belt Male (18 yrs+)**Open Black Belt Female (18 yrs+)**35 to 44 yr Incl. Male35 to 44 yr Incl. Female45 to 54 yr Incl. Male45 to 54 yr Incl. Female55 yr + Male55 yr + FemaleInstructors MaleInstructors Female

Name: Age:

Address: Phone:

Region: Country:

Dojo: Grade:

(at time of competition)

TOURNAMENT DECLARATION 1. I am aware that participation in martial arts, including non-contact GKRtournaments, as with most sports contains a risk of injury.2. In consideration of my acceptance in the competition, I agree that GKRKarate, it’s servants and agents and all persons involved in the organisationof the tournament shall be excluded from liability for loss and damage to thefullest extent permitted by law. I accept that this includes exclusion of liability fornegligence (other than for death or personal injury) and all indirect or consequential

3.competitors in tournaments. It is a condition for acceptance in the competition that the competitor consents to the occurrence and use of such photography and filming.

Signature: Parent’s signature: (If under 18 years of age)

Protective Equipment is Compulsory for KumiteGloves (IGKF/WKF approved only), Shin Protectors & Mouth Guards must be

worn by all competitors. Groin Guards for all male competitors are compulsory. Chest Guards are compulsory for all female competitors from 12 yrs+.

Fee Paid:

Sensei Sign:

Sensei Name:

KUMITE1.

2.

3.

4.

5.

6.

TEAM NAMESKATA1.

2.

3.

ENTRY FEES: $35 First Event, Each Subsequent Event

GRADE DIVISIONS8th to 7th Kyu6th, 5th & 4th Kyu3rd Kyu and above

TEAM EVENTSKataJunior Team Kata 8-4th Kyu (under 18 yrs)Junior Team Kata 3rd Kyu + (under 18 yrs)Team Kata Male 8-4th Kyu (18+ yrs)Team Kata Male 3rd Kyu + (18+ yrs)Team Kata Female 8-4th Kyu (18+ yrs)Team Kata Female 3rd Kyu + (18+ yrs)

KumiteJunior Team Kumite (3 Male, 3 Female - 14 to 17 yrs)Senior Team Kumite (3 Male, 3 Female - 18+ yrs)

ENTRY FORM

State Titles

Please circle YES or NO to the following questions and statements. (If the answer is YES to any of these questions, please give details.)Do you have any allergies? e.g. aspirin; antibiotics; foods? YES NOAre you taking any form of medication at present?

Doctor’s Details:

Emergency Contact Details:

Declaration (Delete as applicable)

I / my son / daughter is capable of taking part in the GKR Karate Tournament.I am willing to allow my son/daughter to participate in the above activwith/without a parent/guardian/a nominated person who has agreed to supervise my child.

1. Name: Relationship:

Phone: Other No:

2. Name: Relationship:

Phone No: Other No:

1. Name: Phone:

Address:

If yes, please give details:

Signed: Date:

Name (Please print):

State Titles

PLEASE CHARGE MY CARD VISA MASTERCARD

Credit Card Number CVV

Name on Card: Signature: Amount: $

Expiry Date/

Competitor Payment Details

ENTRY FEES: $35 First Event, Each Subsequent Event

EACH SUBSEQUENT EVENT

Family (2 adults & 2 children) $25(children under 5 yrs free)

Closing date for entries:(Late entries will attract a fee)

& AUS NATIONAL CHAMPIONSHIPS QUALIFIER

Spectator: Adult , Child ,

TOURNAMENT INFORMATION

State Titles

Once a competitor qualifies for the Australian Championships in any one event (eg: Kata, Kumite, Team Kata) they will automatically gain qualification to compete in ALL events in their division.

NO ENTRIES WILL BE ACCEPTED ON THE DAYAll fees are strictly non-refundable.

COMPETITORS SAFETY EQUIPMENT IS COMPULSORYSafety equipment includes: Mouth Guard, Shin Protectors, Gloves (IGKF/WKF approved only), Groin Guard, Women’s Chest Guard (12 yrs+).

AUSTRALIAN CHAMPIONSHIPS QUALIFICATION CRITERIAIndividual Qualification

Team Qualification – Kata

Team Qualification – KumiteAll team kumite teams for the Australian Championships will be selected by the State Coaches and Regional Instructors. Students will be notified of their selection where applicable

Finishing in the Top 3 at the 2018 State TitlesFinishing in the Top 3 of any other GKR Karate tournament in 2018

Finishing in the Top 6 of any individual event at the 2018 State TitlesFinishing in the Top 3 of any GKR Karate tournament in 2018

$35