Driving Directions:

From San Francisco or north of Palo Alto,

- Take HWY 101 south

- Exit onto Embarcadero Rd.

- Go Straight until Embarcadero/El Camino intersection

- Go Straight through intersection to get onto Galvez St. (Embarcadero becomes Galvez)

- Keep Left on Galvez

- Turn Left onto Campus Drive East

- Parking lot is on the Right just after the cross walk between Maples Pavilion and the tennis courts

Tournament is at Arrillaga Center for Sports and Recreation, across from the Ford Center

Map of parking lot and Rec Center:

Map

Stanford Kids Judo Clinic

May 13, 2007

Arrillaga Center for Sports and Recreation

Stanford University

Official Use Only

CHK. # __________

VERIFY: _________

Contestant Weight: _________

________________________________________________________________________

OFFICIAL ENTRY FORM

PLEASE PRINT ALL INFORMATION:

NAME: _____________________________________________________DATE OF BIRTH: _____/_____/_____

FIRST LAST

SEX: ______________ AGE: ____________ WEIGHT: ______________ RANK (BELT COLOR): ____________

How long have you been practicing Judo: __________ Yrs. ______________ Months

JUDO CLUB: ________________________________________________ INSTRUCTOR: ___________________

USJF #: ______________ Expiration Date: ______________

USJA #: ______________ Expiration Date: ______________

USJI #: ______________ Expiration Date: ______________

HOME ADDRESS: _____________________________________________________________________________

CITY: _______________________________________________ ZIP: ____________________________________

TELEPHONE: _____________________________ NAME OF PARENT: _________________________________

EMERGENCY CONTACT NAME: ________________________________________________________________

EMERGENCY CONTACT PHONE NUMBER: ______________________________________________________

WARNING!

WAIVER AND RELEASE OF LIABILITY AND AGREEMENT TO PARTICIPATE

In consideration of being permitted to participate in any way, including travel to and from, in any Judo tournament, practice, clinic, and related events and activities of the United States Judo, Inc., United States Judo Association, Inc., California Judo, Inc., Stanford Judo Club Team, Stanford University, Stanford Club Sports, and Stanford University Department of Athletics, Physical Education, and Recreation, I hereby:

1. Acknowledge that I am familiar with the sport of Judo and understand the rules governing the sport of Judo.

2. Agree that, prior to participating, I will inspect the mats, equipment, facilities, competition pools or divisions, and the

elimination or scoring system to be used, and if I believe anything is unsafe or beyond my capability, I will immediately advise my coach, supervisor, and/or a tournament official of such conditions and refuse to participate.

3. Acknowledge and fully understand that I will be engaging in a contact sport that might result in serious injury, including permanent disability or death, and severe social and economic losses due not only to my own actions, inactions or negligence, but also to the actions, inactions, or negligence of others, the rules of the sport of Judo, or conditions of the premises or of any equipment used. Further, I acknowledge that there may be other risks not known to me or not reasonably foreseeable at this time.

4. Knowing the risks involved in the sport of Judo, I assume all such risks and accept personal responsibility for the damages following such injury, permanent disability, or death.

5. Release, waive, discharge and covenant not to sue the United States Judo Federation, Inc., United States Judo Association, Inc., California Judo, Inc., Stanford Judo Club Team, Stanford University, Stanford Club Sports, and Stanford University Department of Athletics, Physical Education, and Recreation, together with their affiliated clubs, their respective administrators, directors, agents, coaches, and other employees or volunteers of the organization, event officials, medical personnel, other participants, their parents, guardians, supervisors and coaches, sponsoring agencies, sponsors, advertisers, and if applicable, owners, lessors, and lessees of premises used in conducting the event, all of whom are hereinafter referred to as "Releasees", from any and all claims, demands, losses, or damages on account of injury, including permanent disability and death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the Releasees or otherwise to the fullest extent permitted by law.

I HAVE READ THE ABOVE WARNING, WAIVER, AND RELEASE, UNDERSTAND THAT I GIVE UP

SUBSTANTIAL RIGHTS BY SIGNING IT, AND KNOWING THIS, SIGN IT VOLUNTARILY. I AGREE TO

PARTICIPATE KNOWING THE RISKS AND CONDITIONS INVOLVED AND DO SO ENTIRELY OF MY OWN FREE WILL. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENT/GUARDIAN AS EVIDENCED BY THEIR SIGNATURE BELOW.

_________________________________ ___________________________ _____________

Participant Participant’s Signature Date

FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE

(UNDER AGE 18 AT TIME OF REGISTRATION)

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release, as provided above, of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above, even if arising from their negligence, to the fullest extent permitted by law. I have instructed the minor participant as to the above warnings and conditions and their ramifications.

_________________________________ ___________________________ _____________

Parent/Guardian Parent/Guardian’s Signature Date