Knights Refrigeration presents
10th Portland Open Border Challenge
Saturday 9 July 2022 10AM

Portland Secondary College Gym, Must St, Portland
 
Please ensure that you have read the instructions to correctly complete this form - CLICK HERE FOR INSTRUCTIONS
This entry form to be completed and received with entry fee by no later than 2 July 2022
All student to arrive by 9.30 in preparation for a Tournament march on.

Entry Cost:  $10 

Non - Contact Entry Form

First Name
Surname
Address
Suburb
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Karate Grade
Telephone Number
Email
Instructor Email
Parent/Guardian Name
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Gender
Post Code
Dojo
Date of Birth
Age on day of the tournament
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Conditions of Entry

  • Entry Fee: $10.00 Please pay into this account
BSB: 633000   Acct No: 142432913   Acct Name: Portland Kyokushin Karate Club Further information may be obtained by telephoning Shihan Ron Jorgensen or Sempai Debbie Jorgensen – 0477 387 244

  • Kumite rules will follow the Victorian Kyokushin Karate Association Rules which are available here or on request by emailing Shihan Ron Jorgensen: rdjorgo@gmail.com 
  • Mouth guards & groin guards (males) are compulsory, leg/instep protectors are optional.  
  • Hand mitts are NOT permitted.  See your instructor for advice on proper selection of protective equipment.​
  • The VKKA reserves the right to include males and females in the same age division, or merge divisions if necessary.
  • All competitors must report to their designated ring when advised and stay on that ring until medals are presented.  ​
  • By entering this tournament the competitor (or legal guardian, where the competitor is less than 18 years of age at time of tournament), hereby grants to the organisers (Victorian Kyokushin Karate Association, Inc. and Portland Kyokushin Karate Club) a non-exclusive, non-royalty bearing and non-sublicensable licence to take photographs, record footage or live broadcast of the competitor ('content') and to use the content in any promotional material developed or distributed by the Victorian Kyokushin Karate Association, Inc. and related bodies-corporate.  
Declaration
I, whose electronic acknowledgement of the conditions of entry and email address that appears on this entry form, in consideration and as a condition of the acceptance of my entry in this tournament, hereby waive all and any claim, right or cause of action which I might otherwise have for, or arising out of loss or injury, damage or loss of any description whatsoever which I may suffer or sustain in the course of, or as a consequence upon my entry or participation in this tournament.  In participating in this Portland Open Border Challenge, I am aware, and understand the risk of harm (including personal injury or death, damage to property or economic loss).  I am aware that this sport is "dangerous recreational activity" that involves significant risk of harm.  This waiver, release and discharge shall be and operate separately in favour of all persons, corporations and bodies involved or otherwise in promoting or staging this event and the servants, agents, representatives and officers of them.  I understand that the Victorian Kyokushin Karate Association, Inc. reserves the right to reject any entry which, in its sole judgement, will be detrimental to the tournament.  I will abide by the rules of this Kyokushin tournament.  I acknowledge that I have read and understood the "Conditions of Entry".  
I acknowledge that I have read and understood the conditions of entry and declaration
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