near Mount Dora

FMAC Championships: Clermont vs Mount Dora

Which school will be victorious?

FMAC CHAMPIONSHIP TOURNAMENT FORM

Saturday, May 15th @ Mount Dora

3755 Lake Center Drive, Mount Dora

352-383-0898   mtdorakarate@aol.com

 

 

STUDENT’S NAME:____________________________________________________________________

                                                                 First                                                      Last

PARENT’S NAME:_____________________________________________________________________

ADDRESS:____________________________________________________________________________

CITY:___________________________________STATE:____________ZIP:_______________________

PHONE NUMBER: (HOME)_________________________ (WORK)_____________________________

(CELL)_________________________(EMAIL)________________________________________

STUDENT’S DATE OF BIRTH:______________________________

 

CURRENT RANK (PLEASE FILL IN CURRENT BELT COLOR) THIS INCLUDES IF YOU HAVE A BLACK STRIPE OR NOT_______________________________________________________________

 

I will participate in the following competition venues: (Check any three) Kick rules apply

 

Point Sparring__________Weapons_______Board Breaking_____________________

 

Forms_________________                                     

 

   Padded sword_________________

 

One School will be crowned FMAC Grand Champion! Points will be determined as follows: Each 1st place is 10 points, each 2nd place is 5 points, each 3rd place is 3 points, and each 4th place is 1 point. Whatever school has the most points wins!  Ties will be decided by a form competition. Winning school gets a PIZZA PARTY AND BRAGING RIGHTS!

 

__________10:00AM till ? 1st-2nd place trophies, 3rd-4th place medals………..$25.00 for one, two or  three events. $10.00 each additional event. (Must register by May 11th )

PLEASE MAKE ALL CHECKS PAYABLE TO THE FAMILY MARTIAL ARTS CENTER.

We accept Visa, Master Card and American Express for payments.

 

I agree to waive all claims against any person, school, and associations (including but not limited to the Tae Kwon Do programs located at the Family Martial Arts Center in Clermont and Mount Dora: this includes Master Gary Wayne and Jim Shipley) for any injuries I may sustain.  I likewise assume responsibility for all of my actions in connection with said tournament.  I further understand there are no refunds.

 

Signature of  Student_________________________________________________

 

Signature of Parent (if under 18)________________________________________

 

 

A LATE FEE OF $10.00 IS ASSESSED IF FORMS ARE NOT HANDED IN BY

Tuesday, May 11th

 


Event Date/Time: 5/15/2021 10:00 AM

  • 1 Student Registration
  • Limit One Voucher Per Student
  • Voucher Cannot Be Redeemed After Event ( 5/15/2021 10:00 AM )