Hawaii Pacific Registration

$60.00

Hawaii Pacific Regionals Registration Form
Your email address
Your Phone Number
Physical Contact Policy Determines Division Interaction per Chief Judges "On Site" Accessement.
mm/dd/yyyy
Martial Arts Experiance
Name of your Instructor
Name of Team
Name of Organization you represent
Select Divisions you wish to compete within
Choose your Division (Novice-white/orange- Intermediate-purple/blue- Advanced-green/brown)
Choose your Division (Novice-white/orange- Intermediate-purple/blue- Advanced-green/brown)
Choose your Division (Novice-white/orange- Intermediate-purple/blue- Advanced-green/brown)
Choose your Division (Novice-white/orange- Intermediate-purple/blue- Advanced-green/brown)
Choose your Division (Novice-white/orange- Intermediate-purple/blue- Advanced-green/brown)
Choose your Division (Novice-white/orange- Intermediate-purple/blue- Advanced-green/brown)
Choose your Division (Novice-white/orange- Intermediate-purple/blue- Advanced-green/brown)
Choose your Division (Novice-white/orange- Intermediate-purple/blue- Advanced-green/brown)
Choose your Division (Novice-white/orange- Intermediate-purple/blue- Advanced-green/brown)
I hereby grant the The International Kajukenbo Association llc., its directors, officers, employees, agents, and designees (collectively “IKA”) non-revocable permission to capture my image and likeness in videotapes, motion pictures, recordings, or any other media (collectively “Images”). I acknowledge that the IKA will own such Images and further grant the IKA permission to copyright, display, publish, distribute, use, modify, print and reprint such Images in any manner whatsoever related to the IKA business, including without limitation, publications, advertisements, brochures, web site images, or other electronic displays and transmissions thereof. I further waive any right to inspect or approve the use of the Image by the IKA prior to its use. I forever release and hold the IKA harmless from any and all liability arising out of the use of the Images in any manner or media whatsoever, and waive any and all claims and causes of action relating to use of the Images, including without limitation, claims for invasion of privacy rights or publicity.

I hereby warrant that I am eighteen (18) years old or more and competent to contract in my own name or, if I am less than eighteen years old, that my parent or guardian has signed this release form below. This release is binding on me and my heirs, assignees and personal representatives.
Video Release Form

Conditions

I hereby grant the International Kajukenbo Association llc, its directors, officers, employees, agents, and designees of the IKA non-revocable permission to capture my image and likeness in videotapes, motion pictures, recordings, or any other media (collectively “Images”). I acknowledge that the IKA will own such Images and further grant the IKA permission to copyright, display, publish, distribute, use, modify, print and reprint such Images in any manner whatsoever related to IKA business, including without limitation, publications, advertisements, brochures, web site images, or other electronic displays and transmissions thereof. I further waive any right to inspect or approve the use of the Image by the IKA prior to its use. I forever release and hold the IKA harmless from any and all liability arising out of the use of the Images in any manner or media whatsoever, and waive any and all claims and causes of action relating to use of the Images, including without limitation, claims for invasion of privacy rights or publicity. I hereby warrant that I am eighteen (18) years old or more and competent to contract in my own name or, if I am less than eighteen years old, that my parent or guardian has signed this release form below. This release is binding on me and my heirs, assignees and personal representatives.
General Release of Liability
Yes, I agree to the above General Release of laibility.

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