ALL Fields are required.

First Name

Last Name

Gender

MaleFemale

Phone Number

Age

Date of Birth

Address

City

State

Zip

E-Mail Address

Have you been to the Kumite Classic Before?

YesNo

Are you in good shape to compete?

YesNo

Categories to select:

Push UpsSit UpsChin UpsJump Rope

Division

High School (14-18)Middle School (10-13)Elementary (9 & under)

Would you like help promote the Kidz Challenge by putting up a poster?

YesNo

How did you hear about the Kidz Challenge:

LIABILITY RELEASE, WAIVER, DISCHARGE AND COVENANT NOT TO SUE
This is a legally binding liability release, waiver, discharge and covenant not to sue
I, (print name)

the undersigned hereby release the Western PA Police Athletic League, Kumite International, Kumite Classic Entertainment Corp., 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 agree to indemnify, defend and hold harmless all the above named parties from any liability or compensation. Additionally, I am fully aware of my personal medical condition and hereby certify that I am mentally and physically fit to participate in the Physical Fitness Challenge. (the "Release"), made by me, the undersigned, to Western PA Police Athletic League Kumite International And Kumite Classic Entertainment Corp. I fully recognize that there are dangers and risks to which I may be exposed by participating in the physical fitness activities and workouts at the event, which involve strenuous physical activity and extensive physical contact with other people. I understand and acknowledge that fitness workouts in general have inherent dangers that no amount of care, caution, training, instruction, supervision or expertise can eliminate. With full understanding of the risks involved and despite this Release, I am voluntarily participating in Kidz of Steel physical fitness challenge. I therefore agree to assume and take upon myself all of the risks and responsibilities in any way associated with this activity. I release the Western PA Police Athletic League, Kumite International, Kumite Classic Entertainment Corp., its agents, volunteers, from any and all liability, claims and actions that may arise from injury or harm to me, from my death or from damage to my property in connection with this tournament. Furthermore, I hereby waive any compensation whatsoever for the use of pictures or video production of myself, utilized by those associated with this event, for any promotional use or profit-making at anytime.

Participant Digital Signature

Date

Signature of parent / guardian who assumes
complete responsibility

Date