Name:          Age:            DO B:

Home Number:           Studio No:   

Address:            City:

State:             Zip:

What is the name of your studio?

What is your style?

Who is your instructor?

How long have you been in the martial arts?

What is your rank?            What is your favorite division? 

Did someone recruit you to join?  Yes No                  Who?

Were you a Dojo member last year?  Yes No

Waiver: I, the undersigned, hereby voluntarily submit my application for the attendance and participation of the "DOJO TOURNAMENT CIRCUIT." I do hereby assume full responsibility for any and all damages, injuries and losses that I may sustain or incur in any way while attending and participating.  I hereby waive all claims against the promoter's, staff members, individual sponsors and operators of the Dojo tournament circuit for any claims or injuries that I may sustain.  I understand that any pictures or video taping can be used for marketing and promoting the Dojo tournament circuit.

Signature of Member __________________________________________________________     Date ___________________

Signature of Parent/Legal Guardian if under 18 _______________________________________     Date _________________