USANKF of Northern California, Inc. - USA Grassroots Karate Camp
Date: Jun 25, 2016 to Jun 26, 2016
This Tournament is closed for online registration.
Registration Fee:
Cost:
$85 per day
$160 for both days
Tournament Contact Information:
Eugene Tibon
emtibon@hotmail.com
(209) 406-2776
Venue & Location:
Crossfit 209 Team Elevate (HIP) Facility
3400 E. Eight Mile Road
Stockton, CA 95212
Tournament Information:
Tournament Info Packet: Open
Tournament Background:
Teaching Camp is Sensei Abdesselem Tareq – he will be teaching two - 2 hour segments each day with Crossfit professional Trainers for one hour each day in between Karate of Crossfit training by the Owners and staff of CrossFit 209 Team Elevate Speed School Facility (HIP) Human Improvement Project.
(World Class training by World Class Instructor and Trainers).
(Besides your Karate gi, pads, bring running shoes, shorts, and t-shirts).
Abdesselem Tareq - Resume (partial)
As Coach:
Currently Head Coach Indonesia National Team (4 Gold Medals at Jr. Worlds)
2016 Master Training Camp (France)
2013-2015 Head Coach Thailand National Team (3rd Overall Team, behind Iran and Japan at Asian Pacific Championships
As Competitor: World Ranking #2 WKF K1 Premier League 2011 (-84Kg), Gold Medals President Cujp 2008 (-80Kg) Baku, Azerbajan, Gold Medals President Cup 2007 – Seniors (-80 Kg)- Tehran , Iran, Gold Medals Milan Open 2007 – Seniors (-80 Kg)-Milano, Italy, Gold Medals “Cup of King†2009 – Seniors (-80 Kg)- Rabat, Morocco, Gold French Champ of Regions 2008 – Seniors- Paris, France, Gold French Champ of Regions 2010- Seniors – Paris, France, Gold French Champ of Regions 2011 – Seniors – Paris, France, Silver Medals Dutch Open 2012-K1 Premier League – Netherlands, Silver Medals Istanbul Open 2011-Ki Premier League-Turkey, Silver Medals French Cup 2009 – Seniors – Team- Paris, France, Silver Medals “Copa Del Madrid†2012- Madrid, Spain, Silver Medals Montenegro-Karate Premier League – Montenegro, Silver Medals “Le Hetet Cup†– Seniors (+76 Kg)- Carcassonne, France, Silver Medals Dutch Open 2012 –K1 Premier League- Netherlands
For Information contact National Director Gene Tibon (209) 465-0943 office
Stockton Hilton $129 per night King bed with Sofa Bed -
password (“Grassroots Karateâ€) Room blocks end 6/3/16 register early
Sales Office (209) 956-1310
2323 Grand Canal Blvd. Stockton, CA 95207
web page address is: http://www.hilton.com/en/hi/groups/personalized/S/SCKSTHF-GRASSR-20160624/index.jhtml?WT.mc_id=POG
Medical Release:
By clicking the "I Agree" you are electronically signing this agreement indicating that you have read, and understood the terms and conditions, refund policy, and release of liability, you are 18 years of age or older or the parent or legal guardian of the minor registering for this tournament or event. In the case of registering a minor you attest that the name entered as the parent or legal guardian is the name of the person accepting the agreement and you are in fact the parent or legal guardian of the registered minor.
USANKF of NORTHERN CALIFORNIA, INC. - USA Grassroots Karate Program Camp
June 24 & 25, 2016 - WAIVER AND RELEASE OF LIABILITY
NOTE: THIS FORM MUST BE READ AND SIGNED UNALTERED BEFORE THE PARTICIPANT IS PERMITTED TO TAKE PART IN ANY FUNCTION (I.E., TRAVEL, TRAINING, COMPETITION, PROCESSING, MEETING OR TESTING SESSIONS) AT USANKF of Northern California,Inc.non-profit,USA Grassroots Karate Program Development Camp at the Human Improvement Project(HIP)Crossfit 209 Sport,LLC.3400 E.Eight Mile Rd Stockton,CA., USANKF of Northern Cal,Inc.,Tibon’s Goju Ryu,. BY SIGNING THIS AGREEMENT, THE PARTICIPANT AFFIRMS HAVING READ AND UNDERSTOOD IT AND IS IN AGREEMENT WITH ITS CONTENTS.
(USA Grassroots Karate Camp Registration :) Participant cost is $85 per Day Cost For 2 Days $160_ Make check payable to: USANKF of Northern California, Inc or Credit Card _________________
Number_________________________________________ Exp Date____________________________
IN CONSIDERATION of my involvement in the sport and activities under the auspices of the United States of America National Karate-Do Federation of Northern California, Inc. non-profit 501(c )3, this sponsoring organization at this USA Grassroots Karate Program Development Camp hosted by Human Improvement Project(HIP) Crossfit 209 Sport, LLC., USANKF of Northern Calif. Inc., I acknowledge, appreciate and agree that:
1. RISK IS INHERENT IN PARTICIPATION IN MY SPORT, and in related training and discipline, including risks from the use of equipment and facilities, the risk of injury does exist, as well as the risk of damage to or loss of property; THESE RISKS INCLUDE EXTENSIVE AND SEVERE BODILY INJURY, PARALYSIS, DISMEMBERMENT, DISABILITY, DEATH, HARASSMENT, AND EXPOSURE TO INAPPROPRIATE CONDUCT.
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS; both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERS;
. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual or unnecessary hazard during my presence or participation, I will bring such to the attention of the nearest official immediately.
4. I, FOR MYSELF, AND ON BEHALF OF MY HEIRS, ASSIGNS, PERSONAL REPRESENTATIVES, and NEXT OF KIN, HEREBY RELEASE, HOLD HARMLESS AND PROMISE NOT TO SUE THE UNITED STATES NATIONAL KARATE-DO FEDERATION OF NORTHERN CALIFORNIA, INC.,A NON-PROFIT, HUMAN IMPROVEMENT PROJECT(HIP)CROSSFIT 209 SPORT,LLC, TIBON GOJU RYU, TIGER CLAW, OR OTHER SPONSORING ORGANIZATION, THEIR OFFICERS, COACHES, VOLUNTEERS, STAFF, SPONSORS, AND/OR AGENTS, ("RELEASEES") WITH RESPECT TO ANY AND ALL INJURY AND/OR LOSS ARISING FROM MY PARTICIPATION, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, EXCEPT THAT WHICH IS THE RESULT OF GROSS NEGLIGENCE OR WANTON MISCONDUCT.
5. This Waiver and Release of Liability shall remain valid for the entire calendar year in which it is executed (expiring on December 31 of that year) or until it is expressly revoked by written notice from me to the USANKF of Northern California, Inc. non-profit, Human Improvement Project(HIP) Crossfit 209 Sport, LLC, Tibon’s Goju Ryu, Tiger Claw whichever occurs first; provided however, that any such revocation shall not in any manner affect the waiver and release of liability given hereunder for any acts or occurrences prior to receipt of said written notice by the USANKF of Northern California, Inc., Human Improvement Project(HIP)Crossfit 209 Sport, LLC, Tibon’s Goju Ryu Fighting Arts, Tiger Claw prior to termination of my participation.
I have read this Release of Liability and Waiver Agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement.
Participant’s Signature
Participant’s Name (Printed) Date
FOR PARTICIPANTS OF MINORITY AGE
This is to certify that I/we as parent(s)/guardian(s) with legal responsibility for this participant, do consent and agree not only to his/her release, but also for myself/ourselves, and my/our heirs, assigns and next of kin to release and indemnify the Releases from any and all Liability incident to my/our minor child's involvement as stated above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.
Parent/Legal Guardian Signature Date
Parent/Guardian Name (Please print)
This Tournament is closed for online registration.