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ONLINE REGISTRATION

Referee Registration

California State Taekwondo Championship
Southern Region: Saturday December 5th, 2009 - CSU Dominguez Hills
  1. The CUTA would be honored to have you serve as an official at this event.
  2. Each participating referee will receive: a) An Officiating Certificate; b) Tournament T-Shirt; c) Cash reward by referee rank; d) Invitation to lunch and dinner.
  3. Referees must attend the Referee Meeting on tournament day at 8:00 AM. Coffee & Donuts will be served.
  4. Only the first 40 referees will be accepted.
  5. Referee Attire: CUTA Referee Tie, White Shirt, Black Color Pants, White TKD/Tennis Shoes.
Applicant Information

First Name:   Middle:   Last Name:
Address:
City:   State:   Zip:
Phone: ()   E-mail:
Taekwondo School Name:

Male: Female:   Age:   Belt/Dan #:   Referee Rank:

I am able to officiate as:     Center Referee     Corner Judge

Dinner after tournament:     Yes     No
LIABILITY WAIVER AND CONSENT TO MEDICAL TREATMENT
I hereby submit this registration and liability waiver form to participate in the California State Taekwondo Championship. I certify that the above information is true and correct and hereby release, discharge and waive any and all responsibility of the tournament venues, California Unified Taekwondo Association, Tournament Committee, Referees, Instructors, and other competitors from liability for any injury, including death, and for damage to or loss of property which may be suffered by myself arising out of, or in any way resulting from or attributable in whole or in part to my traveling to, training for, being coached in, using any sports equipment in, or participating in the said event. As a competitor or parent/legal guardian of the competitor, I give consent to any x-ray exam, medical, chiropractic, dental or other treatment(s) deemed necessary for the safety and welfare of the contestant. I understand that this authorization is given prior to any diagnosis, treatments or hospital care being required, but is given to provide the medical/chiropractic/dental staff authority to render care as deemed advisable. In the case of minors, it is understood that efforts shall be made to contact the undersigned prior to rendering treatment, but treatment will not be withheld if the undersigned cannot be reached. I understand that in case of injury, only basic first aid will be made available on site, and that I am fully responsible for any and all resulting medical or other expenses. And I further understand that any pictures taken of me in connection with the Championship may be used by the organizer for publicity or promotion without compensation.
The Liability Waiver and Consent to Medical Treatment is required for all applicants.
E-signature (initials) of Competitor or Parent/Legal Guardian is required:
By entering three letters or initials as your E-signature you accept the conditions above.
Name of Parent/Guardian if applicant is under 18 years of age




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