29th ANNUAL GEN-KI KARATE & KUNG FU OPEN CHAMPIONSHIP REGISTRATION FORM
Name _________________________________________________________________________ Date __________________________
Home Address _________________________________________________________________________________________________
City ________________________________________________ State ________________________________ Zip _________________
Phone ____________________________________ Date of Birth ___________________________ Age ___________ Sex __________
Rank (Kyu & Belt Color)_______________________________________________ Height ________________ Weight ______________
Instructor’s Name ________________________________________________ School or Dojo _______________________________ ___
City _________________________________ State __________________ Zip ______________E-mail___________________________
Waiver
I agree to all the terms & conditions of the liability. I agree to assume full responsibility for any and all damages, injuries or loses that I may sustain or
incur, if any, while attending or participating, and I hereby waive all claims against the promoters, or operators, or sponsors of this Karate Tournament
for any claim, for injuries that may sustain. I fully understand that any medical treatment given to me will be of a first aid treatment only.
Signature_________________________________________ Parent/Guardian Signature________________________________________
Competitor
(if competitor is under 18 years of age)
**CHECK OFF DIVISIONS YOU ARE ENTERING–FORM WILL NOT BE ACCEPTED UNLESS FILLED OUT COMPLETELY**
ADULT BLACK BELT DIVISIONS
Weapons/Musical
Kata
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Men’s Kata-Hard Style (18 to 34 yrs. Old)
Men's Kata-Soft Style (18 to 34 yr. Old)
Women’s Kata-Hard Style *
Women’s Kata-Soft Style *
Seniors (35 yrs. to 39 yrs. old)
Masters (40 yrs .to 49 yrs. old) *
Masters (50 yrs. & over) *
Kata
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Men’s Brown Belt (18 to 34 yrs)
Women’s Brown Belt (18 to 34 yrs)
Men’s G/B/P Belt (18 to 34 yrs)
Women’s G/B/P Belt (18 to 34 yrs)
Men’s W/Y/O Belt (18 to 34 yrs)
Women’s W/Y/O Belt (18 to 34 yrs)
Men Seniors (35 & older) Novice *
Men Seniors (35 & older) Advanced *
Women Seniors (35 & older) all kyu’s *
( ) Musical (18 yrs. and over)
( ) Weapons (18 yr. and over)
( ) Master (over 40 yrs. and over)
( ) Creative/Extreme (18 to 35 yrs. old)
( ) Creative/Extreme (36 yrs. & older)
( ) Self Defense
ADULT KYU RANK DIVISIONS
Weapons/Musical
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Musical – Novice (18 yrs & over)
Musical – Advanced (18 yrs & over) *
Weapons – Novice (18 yrs & over) *
Weapons – Advanced (18 & over)
( ) Creative/Extreme - Novice
( ) Creative/Extreme - Advanced
SPECIAL FORMS DIVISION
( ) Competitors with special needs
(handicapped) all ranks
( ) Self Defense
These divisions will be combined if there are less then 3 competitor’s *
Kata
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Young Adults (16 & 17) Novice
Young Adults (16 & 17) Intermediate
Young Adults (16 & 17) Advanced
Teens (13,14 & 15) Novice
Teens (13, 14, & 15) Intermediate
Teens (13, 14 & 15) Advanced
Pre-teens (11 & 12) Novice
Pre-teens (11 & 12) Intermediate
Pre-teens (11 & 12) Advanced
Juniors (9 & 10) Novice
Juniors (9 & 10) Intermediate
Juniors (9 & 10) Advanced
Youth (7 & 8) Novice
Youth (7 & 8) Intermediate
Youth (7 & 8) Advanced
Pee-Wee (5 & 6) All ranks
Kumite
( ) Men's Light (18-34) 149lbs & under
( ) Men’s Middle (18-34) 150lbs to 175 lbs.
( ) Men’s Heavy (18-34) 176lbs & over
( ) Seniors (35 to 39 yrs old)
( ) Masters (40 to 49 yrs. old) *
( ) Masters (50 yrs. & over) *
( ) Women (18 to 34 yrs. old) *
( ) Women (35 yrs. and older) *
Kumite
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) Men’s Brown Belt-Lt 164lbs & < (18-34) *
) Men’s Brown Belt-Hvy165lbs & > “ “ *
) Women’s Brown Belt (18-34)
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) Men’s G/B/P Belt Lt 164lbs & < (18-34) *
) Men’s G/B/P Belt Hvy 165lbs & > “ “ *
) Women’s G/B/P Belt (18 to 34)
) Men’s W/Y/O Belt Hvy 165lbs & > “ “ *
) Men’s W/Y/O Belt-Lt 164lbs & < (18-34) *
) Women’s W/Y/O Belt (18-34)
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) Senior Men (35 yrs & over) Novice
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) Senior Men (35 yrs & over) Advanced *
) Senior Women (35 yrs & over) Novice *
) Senior Women (35 & over) Advanced *
YOUTH DIVISIONS
Kumite
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Young Adult Men (16 & 17) Novice
Young Adult Men (16 & 17) Intermediate
Young Adult Men (16 & 17) Advanced
Young Adult Women (16 & 17) Novice
Young Adult Women (16 & 17) Intermediate*
Young Adult Women (16 & 17) Advanced
Teen Boys (13, 14 & 15) Novice
Teen Boys (13, 14 & 15) Intermediate*
Teen Boys (13, 14 & 15) Advanced
Teen Girls (13, 14 & 15) Novice
Teen Girls (13, 14 & 15) Intermediate*
Teen Girls (13, 14 & 15) Advanced
Pre-teen Boys (11 & 12) Novice
Pre-teen Boys (11 & 12) Intermediate*
Pre-teen Boys (11 & 12) Advanced
Pre-teen Girls (11 & 12) Novice
( ) Pre-teen Girls (11 & 12) Advanced
( ) Junior Boys (9 & 10) Novice
( ) Junior Boys (9 & 10) Intermediate*
( ) Junior Boys (9 & 10) Advanced
( ) Junior Girls (9 & 10) Novice
( ) Junior Girls (9 & 10) Intermediate*
( ) Youth Weapons (13 to 17) Intermediate
( ) Junior Girls (9 & 10) Advanced
( ) Youth Boys & Girls (7 & 8) Novice
( ) Youth Boys & Girls (7 & 8) Intermediate*
( ) Youth Boys & Girls(7 & 8) Advanced
( ) Pee-Wee (5 & 6) All ranks
( ) Dynomites (3 & 4) All ranks
( ) Dynomites (3 & 4) All ranks
( ) Pre-teen Girls (11 & 12) Intermediate*
29th ANNUAL GEN-KI KARATE & KUNG FU OPEN CHAMPIONSHIP REGISTRATION FORM
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Weapons/Musical (These divisions include boys & girls)
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Youth Weapons (13 to 17) Novice
Youth Weapons (13 to 17) Advanced
Youth Weapons (12 & under) Novice
Youth Weapons (12 & under) Intermediate
Youth Weapons (12 & under) Advanced
Youth Musical (13 to 17) Novice *
Youth Musical (13 to 17) Advanced *
Youth Musical (12 & under) Novice *
Youth Musical (12 & under) Advanced *
Creative/Extreme (17 & under) Novice *
Creative/Extreme (17 & under) Intermediate *
Creative/Extreme (17 & under) Advanced *
* Above divisions will be combined if there are less than 3 competitors
Youth Kumite Height Limits: Dynomites 3’6”- Pee-Wees 4’ - Youth 4’6” – Juniors 5’ - Pre-teens 5’4” – Teens – 5’8” - Young Adults none
ENTRY FEES
Pre-Registration:
$40.00 for 1 or all events
# of events entering: ______________
Total amt. Enclosed: $_____________
Make check payable to Jerry Weiss.
DEADLINE: OCTOBER 11th
Day of Event:
$45.00 for 1 or 2 events
$5.00 for each additional event
# of events entering: ______________
Total amt. Enclosed: $_____________
OFFICE USE ONLY:
REC’D BY:__________________DATE:________________
Method of Payment_________________________________
Please make check payable to Jerry Weiss.
Thank you for your support!