Championship | Himalayan Taekwondo

1st Himalayan Open Taekwondo Champaionship Athlete's Entry Form

First name

Last name

Phone

Date of Birth

Age

Height

Weight in LB

Belt Color

Dan

Select an Address

Type if your address has Apt/Suite/Other

Guardian's Name

Guardian's Phone

Guardian Email

Master/Instructor Name

TKD Academy Name

Select an Address

Type if address has Apt/Suite/Other

Please type the event names that you will participate in the box below form the list of our Events:
1. Poomsae: Open / World TKD Official Poomsae.

2. Kyeorugi : Open / World Class
3.Board Breaking

Name or Names of the Event to Participate

Date: 16th of September, 2023. Location: 2801 N 3rd Street #2, Harrisburg, PA 17110. Fee(s): Early registration Through 07/30/2023: $80 for one and $20 for each additional Event. Late Registration (After 08/30/2023): $90 for One and $25 for each additional Evant. Mail in Registration must be postmarked by 08/30/2023. Cash, Money Orders or Cashier check only. Mail to Himalayan Taekwondo, 200 N 34th Street Harrisburg PA 17109. Call or Tex: 717-425-1441/24070-55880. Email: himalayantaekwondo@gmail.com.

Liability Waiver: I hereby submit my application to the 1st National Open Taekwondo Championship. I understand that Taekwondo is a physical Contact Sport which involves the risk of injury. I agree that I will be responsible for all cases of accidents such as any damage, loss and injury etc. Which occur during physical exercise and competition or demonstration till the finish of the tournament. I agree that the organization committee for the 1st National Open Taekwondo Championship including organizers, staff and volunteers as well as venue staff, referees, Masters, instructors, coaches, fellow competitors, staff except competitor herself/himself will be indemnified from all accident as above and release and forever discharge from any claim for damages. I also agree that the medical treatment provided by the organization committee, if necessary, will be first aid type only. I further agree that all video recordings, pictures and photography taken of or by me in connection with the championship may be used by the tournament director for publicity or promotion without compensation at this time or any other time.

I agree to the terms & conditions mentioned above

By agreeing above and signing below, I hereby acknowledge that I have completely read and fully understand that I will be responsible for all cases of accidents such as damage, loss, and injury I also affirm the truth of the following statements:

I am older than 18 or I am the parent or legal guardian for the minor.

Your Signature

Your Full Name

Today's Date

Select an amount below based on number of events you would like to participate

Single Event - $80

With One Additonal Event - $100

With Two Additional Event - $120

Thanks for registering!

HIMALAYAN TAEKWONDO SCHOOL

200 N 34th street Harrisburg PA 17109

1st Himalayan Open Taekwondo Champaionship Athlete's Entry Form

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