Medical Release Form (Athletes)

EAST OF SCOTLAND

PHYSICAL AND INTELLECTUAL DISABILITY JUDO

OPEN CHAMPIONSHIPS 2015

Point Scoring Event

Venue:Craigswood Sports Centre

Livingston

Scotland

EH54 5ER

Date:Saturday 25th April 2015

Registration 9.30 – 10.00am

Closing Date:All entries with payment should be received by Saturday 18th April 2015

Elegibility Players must be a minimum of 8 years of age.

There is no upper age limit.

All players must hold a full licence of one of the following

governing bodies – Judo Scotland, BJA, WJA, NIJF, BJC, and AJA

Weight Categories:Junior Boys: U27, U30, U34, U38, U42, U46, U50, U55, U60, U66, U73, Over 73kg

Junior Girls: U28, U32, U36, U40, U44, U48, U52, U57, U63, Over 63kg

Senior Men: U50, U55, U60, U66, U73, U81, U90, U100, Over 100kg

Senior Ladies: U48, U52, U57, U63, U70, U78, Over 78kg

Entry Fee:£18.00

Cheques/Postal Orders made payable to East Scotland Special Needs Judo (ESSN)

Spectators:AdultsFree

ChildrenFree

Send Entry To:East of Scotland Physical and Intellectual Judo Group

81/7 Murrayburn Park,

Edinburgh,

EH14 2PS

Contact Tel. No:Jo 07411722240

Janice 0131 453 1269 (evenings please)

Email:

Please do get in touch if you need any assistance or need further advice,

we are happy to help.

The Organisers have the right to combine weight / age categories if necessary

Athlete Entry Form

Please complete the form fully in BLOCK CAPITIALS

Surname:
Forenames:
Phone No:
Alternative Phone No:
Email:
Address:
Post Code:
Date of Birth:
Age:
Gender: / M / F
Club:
Judo Licence No:
Judo Grade
Disability:
Weight / Judo Contest Level (1-5) / Kg Level 1 2 3 4 5 (please circle)
Starting Position / Standing Kneeling Sitting
Club Coach / Parent/ Carer Declaration:
I certify that this athlete is eligible to participate in the East of Scotland Physical and Intellectual Disability Judo Competition
Print Name of Coach/ Parent/ Carer:
Signed by Coach/ Parent/ Carer:
Date:

Parent /Guardian Medical Declaration

I the undersigned being the parent/legal guardian of:
Hereby give my permission to allow him/her to be treated as and when necessary by the medical team on duty at the championships.
Signed by Parent/Guardian
Date: / / /2015

Medical Release Form (Judoka)

Athlete’s Full Name:
Contact Person in case of Emergency
Emergency Contact Number
Health Information
Down Syndrome / Yes / No
If yes x-ray done for check of
Atlanto- Axial instability / Yes / No
Results:
Bleeding Problem / Yes / No
Diabetes: / Yes / No
Heart Problems: / Yes / No
Recent Contagious Disease / Yes / No
Kidney Problem: / Yes / No
Epilepsy: / Yes / No
Vision Problem: / Yes / No
Hearing Problem: / Yes / No
Allergies: / Yes / No

Release Form (Judoka)

Name of Parent / Guardian:
Name of Judoka:
I am above mentioned judoka’s parent/guardian and I hereby confirm that he/she has my authorisation to participate in the East of Scotland Physical and Intellectual Disability Judo Championships to be held on Saturday 25th April 2015 at Craigswood Sports Centre, Livingston, EH54 5ER
I further confirm and warrant that to the best of my knowledge and belief that the judoka is able to participate in the Judo Tournament.
In permitting the judoka in participating, I am specifically granting my permission to the ESSN, to use the judoka’s likeness, name, voice and words in television, radio, film, newspaper, magazines and other media and in any form for the purpose of advertising of communicating the purposes and activities of the ESSN and / or for applying for funds to support these purposes.
If a medical emergency should arise during the athlete’s participation in this tournament, at a time when I am not personally present so as to be consulted regarding the judoka’s care, I hereby authorise the ESSN on my behalf, to take whatever measures are necessary to insure that the judoka is provided with any emergency medical treatment, including hospitalisation, which the ESSN deems advisable in order to protect the judoka’s health and well-being.
I the undersigned am parent/guardian of the above-specified judoka and I hereby give my permission for:
Athletes Name:
to participate at the East of Scotland Physical and Intellectual Disability Judo Championships 2015
Signed by Parent / Guardian:
Date: / / / 2015
N.B: If a judoka is an adult and legally responsible for him/her, he/she can sign this form
Signature of Judoka if of legal age:
Date: / / / 2015

Return the completed form by: SATURDAY 18thAPRIL 2015

TO:East of Scotland Physical and Intellectual Disability Judo Group

81/7 Murrayburn Park

Edinburgh

EH14 2PS

LEVEL 1(Good player)

A judoka, who can train and compete with mainstream players at club level. This judoka has a good understanding of the meaning and goal of the competition.

(CRITERIA: This judoka is capable of taking part in national and international championships).

LEVEL 2 (Medium/Good player)

A judoka, who can train and take part in light competition (RANDORI) with mainstream players. This judoka understands the meaning and goal of the competition.

(CRITERIA: This judoka is capable of taking part in local championships and tournaments).

LEVEL 3 (Medium Player)

A judoka, who can take part in training with mainstream players but only competes in special competitions with judoka’s of the same level.

CRITERIA: This judoka understands most of the rules, meaning and goal of the competition.)

LEVEL 4 (Medium/Weak Player)

A Judoka, who is only capable of taking part in special training and competitions. This judoka needs guiding during the competition but understands most of the rules and goal of a competition

(CRITERIA: This judoka needs guiding during the competition but understands most of the rules and goal of a competition).

LEVEL 5 (Weak Player)

A Judoka who is only capable of taking part in special training and competitions with specialist care. This judoka needs a lot of guidance during the competition. The competition is adjusted to the judoka. This judoka competes in games of romps on the ground (ne-waza) mainly for safety reasons.

(CRITERIA: This judoka needs a lot of guidance during the competition. The competition is adjusted to the judoka’s in games of romps form.

Coaches and Parents Please be Honest in Your Players Level