THE KURO BUSHI MARTIAL ARTS GRAPPLING REGISTRATION
Name:
Street Address:
City, State, & Zip:
Email address:
Phone Number:
Gender:	Male Female
Age:(as of January 1, 2018)
Weight:
Years of Experience:
Instructor / School:
Emergancy Contact:
Online Registration: If registering online, you must send in your payment to: K.B.M.A. 435 Ranch Wood Dr. N.C. 28146 After you have submit your online registration Please send in your payment, failure to submit payment will void your registration and you will not be added to the competitors list. OR you can pay online now Click here to make a payment
	NO-GI (Grappling)
Division Category:	Adult Male (18-29) Executive (50+) Masters (30+) Women (18-29) Teen (13-17) Youth (12 and Under) Choose One Directors (40+)
GI (Jiu-Jitsu) Experience:	White Blue Purple Brown Black Choose One
	Karate Division
If you wish to (cross over) enter both GI & Karate or No-GI you must register for both at the same time.  No Exceptions.  We reserve the right to expand, create, or combine divisions to accommodate competitors or special circumstances.  Information subject to change at the discretion of the Coordinator and Head Referee. TOURNAMENT RELEASE AND WAIVER I,(print Name) the undersigned, herby wiave all claims against the Kuro Bushi Martial Arts Organiation, Ernest Dukes, Central Cabarrus High School, and any and all other persons associated with this event in any capacity from any and all liability due to injuries that I may incur as a result of my attendance and/or participation at this event. I understand the ruels of the tournament and will abide by them. I understand that I am participating in a sport that has body contact. I assume full responsibility for all of my actions during and connected to the above tournament. I understand the risk of competing in this form of Martial Arts competition and hereby release the event organizers and all of its employees and associates, tournament sponsors, and the event facility, from any type of injury, loss, or death sustained while competing in this competition. Divisions or weight classes are subject to change. In case of an emergency, I hereby authorize any licensed medical personnel to perform any accepted medical procedure deemed necessary and I agree to bear the expense of any such treatment. I also agree that my attendance and / or performance at the tournament may be photographed, filmed, or taped and used by any schools and I waive any compensation thereof. I have read, understand and agree to abide by the rules associated with this event and assume all responsibility and any associated liability for infringement of such rules. By checking this box, I agree to this waiver. Enter Name of person who is responsible (Parent or Guardian if child is under 18) and date below:

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