2014 Intramural Games Student Kung Fu Competition
2014 Intramural Games Student Kung Fu Competition
Saturday, December 13, 2014 • 9:30 – 5:30 pm
Venue: Shaolin Temple Culture Center, 4343 Peralta Blvd., Fremont, CA 94536
Registration FormTraining Location:
First Name: Last Name:Student #Belt Level:
Date of Birth:Age:Tel: E-Mail:
EVENT #EVENT/FORM NAMEFEE
1st individual event#$ ($20/person)
2nd individual event#$ ($15/person)
3rd individual event#$ ($15/person)
4th individual event#$ ($15/person)
Team event# 34$ ($15/person)
Family event# 35$($15/person)
Sparring# 36$($15/person)
Total Amount Due:$
Payment Method:
( ) Cash( ) CheckBank:Check #Date:
( ) Visa ( ) MastercardCard #Expiration Date:Security Code:
Card Holder Name:Billing Address:
Card Holder Signature to authorize electronic payment from this credit card:Date:
I confirm that I have read, understand and agree to abide by the competition rules and the followingterms and conditions.
1.Completed registration form and all fees must be received by Shaolin Temple USA on or before 11/30/2014 to qualify for participation in competition. 2. There will be NO refund for any registration, including withdrawal or absence from any event regardless of reason. 3. I accept all rules and regulations set forth by Shaolin Temple USA for this event. Events and rules are subject to change without notice. 4. Events may be combined or canceled due to insufficient participants.
Waiver and Release
1. Assumption of Risk. I AM AWARE THAT PARTICIPATION IN A KUNG FU/MARTIAL ARTS COMPETITION IS A HAZARDOUS ACTIVITY. I AM VOLUNTARILY PARTICIPATING IN THESE ACTIVITIES WITH KNOWLEDGE OF THE DANGER INVOLVED, HEREBY AGREE TO ACCEPT ANY AND ALL RISKS OF INJURY OR DEATH, AND VERIFY THIS STATEMENT BY PLACING MY SIGNATURE BELOW: 2. Release. As consideration for being permitted by Shaolin Temple USA to participate in these activities and use related facilities, I hereby agree that I, my assignees, heirs, distributees, guardians, and legal representatives will not make a claim against, sue, or attach the property of Shaolin Temple USA on account of injury or damage resulting from the negligence or other acts, howsoever caused, by any employee, agent, or contractor of Shaolin Temple USA as a result of my participation in the competition. I hereby release Shaolin Temple USA from all actions, claims, or demands that I, my assignees, heirs, distributees, guardians, and legal representatives now have or may hereafter have for injury or damage resulting from my participation in the competition. 3. Photo and Video Release.I understand that during the SHAOLIN TEMPLE USA 2014 INTRAMURAL GAMES STUDENTS KUNG FU COMPETITION photographs and videos may be taken of me before, during or after the competition, that the same may be used for publicity for Shaolin Temple USA, Shaolin Temple Culture Centers, and the same may be used for television or on the Internet, and I waive all rights, title and interest in such photographs or video and waive all claims to compensation for them.4. Knowing and Voluntary Execution. I HAVE CAREFULLY READ THIS RELEASE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN ME AND SHAOLIN TEMPLUE USA AND SIGN IT ON MY OWN FREE WILL.
Signature of StudentDate
Signature of Parent/Legal Guardian if under 18 Relationship to StudentDate
v.2014.10.30
1. Voluntary Participation. I, ______, acknowledge that I have voluntarily applied to participate in the SHAOLIN TEMPLE USA 2011 FALL INTRAMURAL GAMES STUDENTS KUNG FU COMPETITION to be held on Sunday, November 20, 2011 at 5509 Geary Blvd., San Francisco, CA 94121.
2. Assumption of Risk. I AM AWARE THAT PARTICIPATION IN A KUNG FU/MARTIAL ARTS COMPETITION IS A HAZARDOUS ACTIVITY. I AM VOLUNTARILY PARTICIPATING IN THESE ACTIVITIES WITH KNOWLEDGE OF THE DANGER INVOLVED, HEREBY AGREE TO ACCEPT ANY AND ALL RISKS OF INJURY OR DEATH, AND VERIFY THIS STATEMENT BY PLACING MY SIGNATURE BELOW:
3. Release. As consideration for being permitted by Shaolin Temple USA to participate in these activities and use related facilities, I hereby agree that I, my assignees, heirs, distributees, guardians, and legal representatives will not make a claim against, sue, or attach the property of Shaolin Temple USA on account of injury or damage resulting from the negligence or other acts, howsoever caused, by any employee, agent, or contractor of Shaolin Temple USA as a result of my participation in the competition. I hereby release Shaolin Temple USA from all actions, claims, or demands that I, my assignees, heirs, distributees, guardians, and legal representatives now have or may hereafter have for injury or damage resulting from my participation in the competition.
4. I understand that during the THE SHAOLIN TEMPLE USA 2011 FALL INTRAMURAL GAMES STUDENTS KUNG FU COMPETITION photographs and videos may be taken of me before, during or after the competition, that the same may be used for publicity for Shaolin Temple USA, Shaolin Temple Culture Centers, and the same may be used for television or on the Internet, and I waive all rights, title and interest in such photographs or video and waive all claims to compensation for them.
5. Knowing and Voluntary Execution. I HAVE CAREFULLY READ THIS RELEASE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN ME AND SHAOLIN TEMPLUE USA AND SIGN IT ON MY OWN FREE WILL.
Name:Student No.:
Date of Birth:Age:Belt Level:
Event #Event NameFee
2012 Shaolin Temple DayArt • Poetry • Essay Contest
Theme:Shaolin In My Heart
ENTRY FORM
Name:
First Last
Address: City State Zip
Telephone: E-Mail AddressOccupation (option)
I am a ( ) student( ) alumnus of Shaolin Temple USATraining Location:
( ) parent or family member, explain relationship:
Age:( ) 7 years or younger( ) 7-14
( ) 15-20( ) 21-29( ) 30-39 ( ) 40-49( ) 50-59( ) 60 +
Occupation (optional):
Title of Work:
Type of Work:( ) Art Size:(8.5”x11” to 24”x36”)
Medium:(crayon on paper, oil on canvas, etc.)
( ) PoetryNumber of lines:(Up to 30 lines)
( ) Essay Number of words:(English: 300-1,500 words; Chinese: 500-2,000 words)
Artist/Author Statement of Originality (Describe your work and explain in 50-100 words what inspired the work):
I confirm that I have read, understand and agree to abide by the contest rules and the followingterms and conditions.
Artist/Author Release Agreement
I certify that the above artwork/literature (poetry/essay) and any accompanying artist/author statement were made by the person indicated, and were not copied from another source, or made by another. I understand that the artwork/literature and any associated artist/author statement will not be returned. Shaolin Temple USA is not responsible for any lost I incur in my attempt to deliver, mail or ship my entry to Shaolin Temple USA. I give permission to Shaolin Temple USA to use, reproduce, prepare derivative works, publish, distribute copies to the public, perform publicly, and display publicly the artwork/literature, any accompanying artist/author statement, and the artist/author’s name for all purposes deemed appropriate by Shaolin Temple USA. Shaolin Temple USA may distribute the artwork/literature through a variety of media, including but not limited to print, television, websites, or any other means. Shaolin Temple USA may also permit a third party to exercise Shaolin Temple USA rights, including but not limited to the right to display or distribute the artwork/literature, in a manner Shaolin Temple USA deems appropriate. Shaolin Temple USA reserves the sole right to (1) interpret, modify, add or retract any and all aspects of the contests without notice; and (2) determine the winners of all categories.
Signatureof Artist/AuthorDate
Signatureof Parent/Guardian if under 18Relationship to Artist/AuthorDate
F120321b