2013 SMART NATIONAL AGE-GROUP

TAEKWONDO CHAMPIONSHIPS
NOTE: KINDLY FILL-UP ALL THE INFORMATION NEEDED IN CAPITAL LETTERS.
FIRST NAME M.I. LAST NAME

NAME: CHAPTER: INSTRUCTOR: GENDER: AGE: BELT:

TO BE FILLED BY WEIGH-IN OFFICIAL

DATE OF LATEST PROMOTION BELT:

TEL. NO:
CELL. NO:

HEIGHT (cms): DIVISION:

WEIGHT(kilos): CATEGORY:

INSTRUCTIONS 1. For contestants in the Children and Junior Divisions please attach a clear, unaltered copy of a proof of age (birth certificate, baptismal certificate, passport) or present your PTA Electronic ID. 2. Contestants agree to be bound by the competition rules and regulations. Penalties shall be imposed for violations of the rules. 3. PTA Electronic ID holders need not submit any proof of age. CERTIFICATION AND WAIVER 1. I hereby certify that the above information is true and correct. 2. I do hereby waive and release any and all rights and claims for damages against the competition officials, their respective agents, or any facility of this competition, from any and all injuries which may be sustained during this competition. 3. I allow PTA to send us and e-mail to us (only for SMART/Talk 'N Text/Red Mobile subscriber).

CONTESTANT'S SIGNATURE

PARENT'S / GUARDIAN'S NAME & SIGNATURE

PHILIPPINE TAEKWONDO ASSOCIATION

INFOBOARD
Name of the Member: Mobile No: Parent's Mobile No. (for minors): Classification: Coach Referee Player Parent/Supporter TBB/TBS PTC

I allow PTA and SMART to send us SMS and E-mail (For Smart, Talk 'N Text, and Red Mobile subscribers only).

Signature

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