Tournament
Committee only:
M F Age:
______________ Rank: ____________________ Weight: ______________ Date
Rec’d:________________
REGISTRATION FORM
TOHOKU JUDO
CLUB’S
21st
ANNUAL CHARLES A. CHAVES MEMORIAL TOURNAMENT
TOURNAMENT SITE: MEDFORD
HIGH SCHOOL, 489 Winthrop St., Medford, MA
Complete and mail with entry fee to: TOURNAMENT COMMITTEE, C/O DALE SWETT
123
SHARON ST., WEST MEDFORD, MA 02155
Registration Fees: $22.00
one division, if postmarked by November 2, 2002; $8.00 for each additional division,. Late entry after November 2nd is $30.00 (add’l
divisions are still $8.00 each)
All
fees are payable to: “Tohoku Judo
Club”.
PLEASE PRINT
ALL INFORMATION:
CONTESTANT’S NAME: ________________________________________________________________
Address: ____________________________________________________________________________
City:______________________________________ State:____________ Zip: _________________
Tel.#
(days)____________________ (nights) ____________________ email: _________________________
Birth
Date:________________ Age:
____________ Weight:____________ Sex:_____________
Judo Club: ____________________________________ Judo Rank: _____________________________
Name
of Club Coach: ______________________________________________________________________
Affiliation
(circle one): USJF USJA USJI Membership Card No. __________________
Expiration
Date: ______________________
THE
WARNING, WAIVER AND RELEASE OF LIABILITY AND AGREEMENT TO PARTICIPATE FORM
MUST BE COMPLETED AND RETURNED WITH THIS REGISTRATION FORM
Boys & Girls 5 -
6 Light / Medium /
Heavy
Boys & Girls 7 -
8 Light / Medium /
Heavy
Boys 9 - 12 -65 -72 -79 -88 -97 -110 -125 +126
Boys 13 - 16 -89 -99 -110 -121 -131 -145 -161 +161
Girls 9 - 12 Light
/ Medium / Heavy / Open -- To be
Determined by No. of Competitors
Girls 13 - 16 Light / Medium /
Heavy / Open -- To be Determined
by No. of Competitors
Women
17+ Light / Medium /
Heavy
Men – Nikyu and
higher 17+ -132 -145 -161 -178 -198 -220 +221
All ages are
as of November 9, 2002. Tournament
Director reserves the right to add,
combine or
cancel divisions dependent upon the number of competitors.
21st ANNUAL
CHARLES A. CHAVES
MEMORIAL
TOURNAMENT
SATURDAY,
NOVEMBER 9, 2002
TOURNAMENT DIRECTOR: CLARK EDSON USJF SANCTION
SITE: MEDFORD HIGH SCHOOL, 489 Winthrop
St., Medford, MA
WEIGH-IN: Juniors
& Seniors: Friday, Nov. 8th;
6:30 pm – 9:00 pm at TOHOKU JUDO CLUB
Juniors: Saturday,
November 9th from 9:00 am
to 10:00 am at Medford High
Seniors: Saturday, November 9th from 10:00
am to 12:30 pm at Medford High
Competition
for Juniors will begin at approximately 10:45 am
Competition
for Seniors will begin at approximately
1:30 pm *
(*Starting time may be
later contingent on number of competitors)
FEES: Early
Registration -- $22.00 for one division; $8.00 for each add’l division, if
postmarked by November 2, 2002.
Late Registration after November 2nd is $30.00
(add’l divs. are still $8.00 each) [Note: No Refunds.
A $20.00 fee will be charged for any returned check.
All fees are payable to:
“Tohoku Judo Club”.
SPECTATOR
FEE: $2.00/Family
Donation to Benefit MASS. JUDO, INC.
FORMAT: The competition will be double elimination with a pool
system. Each athlete is guaranteed a
minimum of two matches. Yonen, ages 5
& 6, will have 2 minute matches; Yonen, ages 7-12, and all Shonen divisions
will have 3-minute matches; Male Seinen
Kyu Divisions will have 4-minute matches; Male Seinen Dan and all Women’s Open
Rank Divisions will have 5-minute matches.
GOLDEN SCORE RULES MAY
BE IN EFFECT FOR ALL DIVISIONS.
RULES: Current IJF Contest Rules:
Yonen Competitors may not use chokes; Shonen Competitors and Adult White
belt divisions may not use armlocks. [Note: Only 5-6
and 7-8 year old divisions will be co-ed.]
COACHES
MEETING: Approx.
9:45 am—will be announced morning of Tournament. All coaches, delegates, and interested parties should
attend.
AWARDS: 1st – 2nd
– 3rd Place Trophies per division; Junior & Senior Team Awards
(based on points); and Best Competitor Awards (based on IPPON wins) per
category.
ELIGIBILITY: Open to all contestants 5 years of
age, as of 11/09/02, and older. With current USJF, USJI, or USJA membership
(you will be required to show card at competition).
COMPETITOR’S BEHAVIOR: If a competitor commits an act of
vandalism of person or real property at the Medford High School, or any other facility, structure, building or
location associated or related in any way whatsoever to the CHAVES MEMORIAL
TOURNAMENT, immediate disciplinary action will be taken and the competitor will
be suspended from further competition.
The competitor, and/or competitor’s parents, and/or club/school/dojo
agrees to indemnify for any and all losses and damages. The Tournament Director reserves the right
to remove any competitor, coach, parent or spectator from the competition site.
POWER OF ATTORNEY
We
(I) will not be in attendance at the 21st Annual Charles A. Chaves Memorial
Tournament on Saturday, November 9, 2002, therefore, we (I) the parent(s) or
legal guardian(s) of the contestant, [insert name of contestant]
_____________________________________________________ have made, constitute and
appoint [insert name of appointee]
______________________________________________________ my (our) true and lawful
attorney for me (us) and that we (I) might or could do or exercise through any
other person and that he (she) shall deem property or advisable, intending to
vest in him (her) full power and authority to do and perform all and every act
and thing whatsoever requisite and necessary to be done in connection with the
contestant participating in the 21st Annual Charles A. Chaves Memorial
Tournament, registering for the events, receiving medical treatment and make
any other decision as we (I) might or could make or do if personally
present. [NOTE: THE PERSON GRANTED THE POWER OF ATTORNEY
MUST BE OF LEGAL AGE AND BE PRESENT AT THE TOURNAMENT NAMED HEREIN.]
______________________________________ __________________________________ _________________
Signature of Contestant Witness Date
______________________________________ __________________________________ _________________
Signature of Parent(s)
or Legal Guardian(s) Witness Date
CONSENT, LIABILITY WAIVER,
RELEASE, INDEMNIFICATION AGREEMENT, AND POWER OF ATTORNEY
TO BE SIGNED BY PARENT(S)/GUARDIAN(S)
OF CONTESTANT UNDER 18 YEARS OF AGE
We (I) have
explained to the contestant the aforementioned stipulated condition and their
ramifications and we (I) agree and consent to contestant’s registration and
participation at the 21st Annual Charles A. Chaves Memorial Tournament under
the conditions outlined above and to abide by the disciplinary action which may
be taken by representatives of Tohoku Judo Club, USJF, USJA, USJI, City of
Medford or any other party or committee of this tournament in fulfilling the
requirements of the stipulated conditions.
_____________________________________
_____________________________________
________________
Signature of Coach/Team Delegate
Witness Date
_____________________________________
_____________________________________
________________
Signature of Parent(s)
or Legal Guardian(s Witness Date
DIRECTIONS:
From
the North: Routes 128/95 South to Route 93 South to
Exit 32 -- Route 60/Medford Square.
Follow Rt. 60 through Medford Square to Rotary, continue to 2nd
street onto Winthrop St. ***
From
the West: Routes 128/95 North to Route 2 East, to
Exit 29 -- Route 60
Cambridge/Arlington) East toward Arlington, end of ramp take a left and
follow Rt. 60 through Arlington
Center (crossing Massachusetts Avenue) watch signs closely and stay on Rt. 60
through West Medford Square, crossing railroad tracks at Dunkin Donuts. Continue on Rt. 60 to Rotary, go to 4th
street onto Winthrop St. ***
From
the South: Routes 3/93
North to Exit 31-- Route 16/Medford (do not veer toward Medford Square) at the
very end of ramp take a right onto Winthrop Street at Rotary take 3rd street
which is still Winthrop Street -- ***
***
At Rotary: Take Winthrop St. --Nursing Home on your left, then Elks
Hall on your right Continue straight through lights, pass Temple Shalom on
right, next drive on right is the entrance to Medford High School.
PARKING: Enter the school drive take a right and follow the road behind the school
buildings, park in the area near the pool —the door there will be open.
IN THE SCHOOL: Weigh-in and registration areas
will be in the gymnasium and signs will be posted.
AREA HOTELS:
Fitness Room
Available
Area
Restaurants: Chili’s Grill, Bertucci’s,
The Outback Steakhouse, Legal Seafoods
Fitness Room
Available
Area
Restaurants: TGI FRIDAYS, Bertucci’s,
Pizzeria Uno, Joe’s American Bar & Grill
Fitness Room
Available
Area
Restaurants: Nothing in walking
distance—lots of delivery selections
ALSO check –
Lexington, Malden, Medford, Melrose, Waltham
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