NORTH AMERICAN TAE KWON DO CHAMPIONSHIPS ENTRY FORM

NAME IN FULL (PLEASE PRINT):_____________________________________________________________________

ADDRESS:________________________________________________________________________________________

DATE OF BIRTH:_______    _______   ________           AGE:_______                  MALE (     ) FEMALE (     )
                             DAY             MONTH          YEAR

PHONE:________________________          WEIGHT:____________ LBS.

BELT COLOR:____________________ BELT            ____________ STRIPE

BLACK BELT:_____________ DAN BLACK BELT

ENTRY:  SPARRING  $35.00__________PATTERN  $35.00___________ SPARRING & PATTERN  $40.00_________

SCHOOL NAME:___________________________________________________________________________________

STATEMENT OF WAIVER
             I hereby release K.S.Cho college and the Canada Tae Kwon DO Association Inc. I agree to
          waive claims against any persons with the Championships for any injuries or damages which
          may incurr traveling to attend, competing in and returning from the championships November
         14, 1998

                                     DATE:______________________________ 1998

            ____________________________________          ________________________________________________
                     SIGNATURE OF CONTESTANT                                     SIGNATURE OF PARENT OR GUARDIAN IF UNDER 18 YEARS OLD

 FILL OUT THIS FORM COMPLETELY FROM TOP TO BOTTOM 

Disclaimer : This is not an official entry form.  Ask the organizer if you wish to use it.