MILO LITTLE OLYMPICS

CONTESTANT'S APPLICATION FORM & WAIVER

FIRST NAME M.I. LAST NAME

NAME: SCHOOL: DATE OF BIRTH: AGE: BELT DEGREE: INSTRUCTOR: INSTRUCTOR'S TEL. NO: INSTRUCTIONS GENDER: DIVISION:

TO BE FILLED BY WEIGH-IN OFFICIAL

WEIGHT: HEIGHT:

ADVANCE
PLEASE READ!

1. For contestants in the Grade School and High School Divisions please attach a clear, unaltered copy of your birth certificate. Contestants agree to be bound by the competition rules and regulations. Penalties shall be imposed in violating the said rules. 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.

CONTESTANT'S SIGNATURE

PARENT'S / GUARDIAN'S NAME & SIGNATURE

MILO LITTLE OLYMPICS

CONTESTANT'S APPLICATION FORM & WAIVER
FIRST NAME M.I. LAST NAME

NAME: SCHOOL: DATE OF BIRTH: AGE: BELT DEGREE: INSTRUCTOR: INSTRUCTOR'S TEL. NO: INSTRUCTIONS GENDER: DIVISION:

TO BE FILLED BY WEIGH-IN OFFICIAL

WEIGHT: HEIGHT:

ADVANCE
PLEASE READ!

1. For contestants in the Grade School and High School Divisions please attach a clear, unaltered copy of your birth certificate. Contestants agree to be bound by the competition rules and regulations. Penalties shall be imposed in violating the said rules. 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.

CONTESTANT'S SIGNATURE

PARENT'S / GUARDIAN'S NAME & SIGNATURE