Student Registration Form Student Registration Form Student's Name * First * Last Student's Birthdate * Gender (biological sex at birth) * Male Female Phone * Email * Address * Address Address Address City City State State Zip Zip Belt Rank * Select Belt RankNew Student10th gup/white belt9th gup/yellow belt8th gup/orange belt7th gup/orange-stripe6th gup/green belt5th gup/green-stripe4th gup/brown belt3rd gup/brown-stripe2nd gup/red belt1st gup/red-stripe1st Black Belt Pre-test/blue belt2nd Black Belt Pre-test/blue-stripeCho Dan/1st Degree Black BeltE Dan/2nd Degree Black BeltSam Dan/3rd Degree Black BeltSa Dan/4th Degree Black BeltO Dan/5th Degree Black BeltYuk Dan/6th Degree Black BeltOther Belt Rank Monthly Payment Date * Parent/Guardian Name (required for children under 18 years of age) First Last Last Liability Waiver * To the best of my knowledge, I am in good physical condition and fully able to participate in this course. I am fully aware of the risks and hazards connected with the participation in Tang Soo Do, including physical injury or even death, and hereby elect to voluntarily participate in said event, knowing that the associated physical activity may be hazardous to me and my property. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OR LOSS, PROPERTY DAMAGE, OR PERSONAL INJURY, INCLUDING DEATH, that may be sustained by me, or loss or damage to property owned by me, as a result of participation in this course. I further certify that I am at least 18 years of age. If under 18, my parent/guardian is the below signed. I hereby RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE, Joe Goss Karate, Joe Goss, officers, agents, and instructors (hereinafter referred to as RELEASEES) from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or to any property belonging to me, while participating in physical activity, or while on or upon the premises where the event is being conducted. It is my expressed intent that this release and hold harmless agreement shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representative, if I am deceased, and shall be deemed as a RELEASE, WAIVE, DISCHARGE, and CONVENTION TO SUE the above named RELEASEES. I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be constructed in accordance with the laws of the State of Pennsylvania. In signing this release, I acknowledge and represent that I HAVE READ THE FOREGOING Waiver of Liability and Hold Harmless Agreement, UNDERSTAND IT, AND SIGN IT VOLUNTARILY as my own free act and deed; no oral representations, statements or inducements, apart from the foregoing written agreements have been made; and I EXECUTE THIS RELEASE FOR FULL, ADEQUATE AND COMPLETE CONSIDERATION FULLY INTENDING TO BE BOUND BY SAME. Student or Parent/Guardian Signature * I have read and understand the terms stated above. Captcha CLICK HERE TO SUBMIT If you are human, leave this field blank. 2018 INVITATIONAL TOURNAMENT 1513 Scalp Avenue (East Hills Plaza)Johnstown, PA 15904 814-266-7100