Coach Registration Form

2017 Stars and Stripes Taekwondo Open

This is a Coach only Registration Form.

Athletes, Referees, Volunteers, must use another form. Coach Registration ends Thursday October 26th, 2017

Coaches fee is waived if school sends a full-time tournament official. One Official=One Coach

If sending official, please register and then see Coach Pruter for a refund.


October 27, 2017 12:01am [Central Time]
KC Sport Lodge
19310 E 50 Terrace
Independence, MO 64055
(816) 795-7171
INFO:   Please note that this form contains limited capacity items which are sold out. They are displayed grayed out and/or are not selectable.

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Registrant Fee: $0.00



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Billing and Payment
Billing and payment processing for Businesses' events is performed by Member Solutions, Inc. ("MSI"), and this contract is specifically assigned to MSI for all such purposes. Customer knowingly and irrevocably authorizes MSI to charge electronically Customer's bank account and/or credit card for any and all amounts due for Customer's, and anyone registering under Customer's, attendance and participation in the Event. Please note, you may see all or any portion of the following on your bank or credit card statement: "MSI*PRUTERSSPORTTAEKWOND 8882448044 ONLINE REG FEE". Any returned payment will be assessed a $25.00 fee. Any unsuccessful electronic transaction is subject to a $10.00 processing fee. MSI is not responsible for any bank fees incurred by Customer. MSI has the sole right to resubmit returned or declined items (plus applicable fees) without prior notice. BILLING INQUIRIES -- 888-244-8044 or by mail to PO Box 297, Hatboro, PA 19040.

Applicant Agreement
I represent that I am the person who appears on the application above. I acknowledge and agree to the statements, terms and conditions above, as well as any applicable terms and conditions for this registration, and that by typing my name below and completing this registration form, I am electronically signing the document, which will have the same legal effect as the execution of the document by a written signature and shall be valid evidence of my intent and agreement to be bound.

Applicant Signature
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Registration inquiries:
Tournament Committee
info@starsandstripestkd.com
Master Kevin Pruter 816-224-0000
Master France Pruter 816-525-4300
Master Daniel Doering 816-781-3800
= required field
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BARE ESSENTIALS SPORTS MEDICINE CONSENT FOR MEDICAL TREATMENT
I, ____________________________________________, as a participant in the 2017 Stars & Stripes Taekwondo Championships receiving FREE INJURY & HEALTH CARE, consent to the medical treatment for athletic related injuries/illnesses provided by Bare Essentials Sports Medicine Team Personnel and /or Hospital Medical Staff. I authorize treatment by such personnel in the event of injury or illness. I understand medical treatment may include but is not limited to: general first aid care for sports injuries and wounds, evaluation for possible illness or disease, preventative taping, stretching, modalities such as heat or ice, acupuncture, chiropractic care, medication (either over-the-counter or prescription medication, Rx only administered by a physician), soft tissue massage, suturing/stitches, splinting/casting, being fitted for a sling, crutches or orthotics, as well as basic and/or advance life support.

____________________________________________________________________________

As a parent or legal guardian of _____________________________, who is under the age of 18, I hereby authorize medical treatment in the event of an injury or illness or as preventative measures as provided FREE OF CHARGE by a member of Bare Essentials Sports Medicine Personnel and/or Hospital Medical Staff. I understand medical treatment may include but is not limited to: general first aid care for sports injuries and wounds, evaluation for possible illness or disease, preventative taping, stretching, modalities such as heat or ice, acupuncture, chiropractic care, medication (either over-the-counter or prescription medication, RX only administered by a physician), soft tissue massage, suturing/stitches, splinting/casting, being fitted for a sling, crutches or orthotics, as well as basic and/or advance life support.

_______________________________________________________________

All medical evaluations completed by Bare Essentials Sports Medicine Personnel for athletic injuries are considered confidential and will be filed at the Bare Essentials Sports Medicine Office. Copies of medical injury forms can by requested verbally from the BARE ESSENTIALS SPORTS MEDICINE STAFF MEMBER EVALUATING THE ATHLETE, by the injured athlete, or parent of a minor athlete at the time of injury or requested in writing at a later date. The original injury report form will remain on file in the Bare Essentials Sports Medicine Office. No information about an individual athlete will be released without that athlete's permission in accordance with HIPAA Guidelines. Information pertaining to injury data without using an athlete's name will be released to the Medical Director, the Medical Coordinator, Event Coordinator or their assistants for purposes of injury research and/or injury form filing.

Event Liability Waiver

I agree that I am 18 years or older or the Parent/Guardian of the registrant, agreeing to terms on his/her behalf. By agreeing to these terms, I hereby waive all claims against any and all persons involved with the 2017 Stars and Stripes Open, Pruter's Sport Taekwondo, and KC Sports Lodge for any injuries which may occur before and during my participation in the competition. I also assume full responsibility for my actions during and in connection with said activities. I will abide by all rules and safe practices of martial arts competition. Any misconduct from competitors or spectators can result in disqualification or ejection from the tournament. I agree that my performance and/or attendance at these activities may be filmed and/or recorded with or without my consent, and that the 2017 Stars and Stripes Open, Pruter's Sport Taekwondo and its associates may use my name, likeness, voices, poses, pictures and biographical data concerning me, fully or in part in any language with or without other material, anywhere by means known or devised: and I waive my compensation there of. Tournament entry or spectator fees are non-refundable.
Check this box to indicate that you have read and agree to all of the above terms & conditions