Complete Your Judo Tournament Registration Official Registration "*" indicates required fields Please Print Clearly* First Middle Last Gender*SelectMaleFemaleDate* MM slash DD slash YYYY Belt* Birthdate* Age*Weight*Club Name Sensai* Skill Level (Novice, Intermediate, Advanced, Sensai Please See Definitions on Categories Page) If No Contestant in My Division Can Be Found I Want to*SelectCompete in the Next Higher Weight DivisionCompete in the Next Higher Age DivisionMembership InformationSelectUSA JudoUSJAUSJFUSA TKJOther OrganizationPersonal Information* Street Address City State / Province / Region ZIP / Postal Code Email* PhoneParent or Guardian Info* Tournament Registration Early Bird July 14th - July 21st = $45 General Registration July 22 - August 21st = $55 Late Registration - August 22 - August 26th = $75 ***August 27th Registration Closed***Awareness and Assumption of Risk I am aware that Judo involves risks including risk of personal injury, death, property damage, expense and related losses, including loss of income. Included in these risks are negligence on the part of Beth Messiah Dojo, it’s directors, staff, officials and volunteers, other participants and owners of the facilities, where activities occur. I freely accept and fully assume all such risks and the possibility of personal injury, death, property damage, expense and related losses, including loss of income. I hereby authorize the following named person(s) _______________ to act in my behalf in any and all matters requiring parental consent for my child (contestant named above if under 18) during the period of this event. This authorization included rendering and accepting any and all official medical care and well being of my child during the period of this event.Contestant’s Signature (Minor & Adult)* Date* MM slash DD slash YYYY Parent/ Guardian’s Signature Date (for Contestants Under 18)* Date* MM slash DD slash YYYY Please Make Checks Payable to* Beth Messiah Dojo 1003 63rd Ave. East Bradenton, Florida 34203Payments may also be made through PayPal, Text and Zelle. Waiver must also be completed!PhoneThis field is for validation purposes and should be left unchanged.