Official Website for Goju USA - Winter Haven - Florida

Winter Haven USA Goju

210 Cypress Gardens Boulevard, Winter Haven, FL 33884  ●  863-604-7455            

Competitors  First Name:     Last Name:    Phone:      
               Email Address:
      Age:      Color Belt:
                                 City:    State:  Zip:

                       School/ Dojo:   Instructor:

                        Kumite:    Kata:   Weapons:

 I HEREBY agree that in consideration of my registration to participate in the “Battle on the Ridge Invitational Karate Tournament” hereby referred to as (tournament), on February 11, 2017 and having actual knowledge and appreciation of the nature of this tournament, its activities, skills and risks involved while participating, hereby voluntarily consent to my participation and assume all inherent risks associated with this event


 I HEREBY, while attending and participating in said “tournament” and using the
facilities and equipment thereof, does so at his/her own risk and further assumes full
responsibility for any injuries or damages arising from personal injuries sustained that he/she
may suffer while participating or not on or about the tournament premises of High Point Church
and does hereby forever release and discharge High Point Church, Main Street Dojo’s, Inc., USA
Goju Karate Organization, any individual instructor or instructors employed by Main Street
Dojo’s Inc. or its independent contractors, employees, students, agents, officials, representatives
or volunteers and any other person or persons at Main Street Dojo’s, Inc., from any and all claims,
demands, damages or causes of action, whether known or unknown, anticipated or unanticipated,
resulting from the negligence or not of High Point Church, Main Street Dojo’s, Inc., USA Goju
Karate Organization, or any other individual instructor, tournament judge or volunteer or any
other persons using the premises whether a participant or not and whether employed or not by
Main Street Dojo’s, Inc.’s.


 I further agree that Main Street Dojo’s Inc. or USA Goju Karate Organization shall not be
liable for any damages arising from personal injuries sustained by the participant in, on or about
the premises of any USA Goju Karate Organization School, or at any public or private Karate
Tournament, contest or exhibition whether traveling to or from this or any event. The participant
agrees that any and all pictures, movies, radio or TV appearances of the student may be used by
Main Street Dojo’s Inc. or USA Goju Karate Organization without compensation to the


  I acknowledge that I have fully read and understand the conditions of this registration and liability
release agreement and also warrant that I am in good physical health and that to the best of my knowledge
I do not suffer from high blood pressure, heart ailments, or any latent physical disabilities which, based on
competent medical advice, would preclude me from participation in the Battle on the Ridge Invitational
Karate Tournament. I also grant permission to: Main Street Dojo’s Inc., its representatives and agents to
authorize and obtain medical care from any licensed physician or hospital should I become ill or injured as
a result of my participation in this event, if either a parent or guardian is unavailable to grant
authorization for emergency treatment.


 I further agree to abide by all the rules and regulations set forth by and for this event and accept that my failure to comply with these rules may result in my immediate disqualification from this event, and that no monies will be refunded to me.

 I have read and understand and accept the terms of this waiver and am of legal age of consent:


Other wise I will print out the registration form and have my parent or guardian sign and submit on registration day.

My parent or legal guardian's name is:

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