Referee Registration Form

2017 Stars and Stripes Taekwondo Open

This is a Referee only Registration Form.

Athletes, Coach, Volunteers, must use another form. Coach Registration ends Thursday October 26th, 2017 (11:59 pm)

First we would like to thank all the referees and officials in advance for your support of the Stars and Stripes Taekwondo Open.  

To encourage impartiality in the judging we are offering the following inducements:

$50 stipend for a qualified officials who works all day.

and

$100 stipend for International Referee’s (IR’s) and Two nights lodging at the tournament Hotel.  Transportation to and from the airport can be arranged.  Coach Pruter's Cell Phone number is 816-591-3502.  Mrs. Pruter can be reached at 816-224-0000.

Please fill out the registration form and you will be contacted by the tournament committee. 

All Stars & Stripes officials please wear dark pants with white shirt and tieWe have arranged a hospitality room with complimentary lunch and drinks throughout the day.  Also please arrive before 8:30am for the mandatory coaches and officials meeting.

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.



Please click the button below to finalize your registration.



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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You do not have to be USAT or AAU  certified Referee to Officiate at the 2017 Stars and Stripes.  This is not a USAT or AAU sanctioned event.  
BARE ESSENTIALS SPORTS MEDICINE CONSENT FOR MEDICAL TREATMENT
I, ____________________________________________, as a participant in the 2016 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.

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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.

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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