Who will be Grand Champion??

FMAC CHAMPIONSHIP TOURNAMENT FORM

Saturday, May 21^th @ 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 two) Kick rules apply

Point Sparring__________Weapons_______Board Breaking____________________

Forms_________________                                     

   Padded sword_________________

One Student 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. The student with the most points wins!  Ties will be broken with a form playoff

__________10:00AM till ? 1st-2^nd place trophies, 3^rd-4^th place medals………..$30.00 for one or two  events. $10.00 each additional event. (Must register by May 17th )

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 17th

Event Date/Time: 5/21/2022 12:00 AM