8th Annual Lone Star Invitational 2021 Entry Form


 










































 WHEN



Saturday June 26, 2021



 WHERE



Poteet Martial Arts 1080 Dividend Street


Midlothian, TX 76065 



 ENTRY FEE



 Online Registration $50.00 – Received online or by mail by 6/18/2021


( Same fee for 1 or all events)  


$75.00 – Received online or by mail 6/19/2021-6/25/2021


$100.00 – Day of Tournament


Special Needs Competitors  – No Charge



 COLOR BELT & SPECIAL NEEDS



1st/2nd/3rd & Alternate Bronze awarded in all Color events with 4 or more competitors.


 



 BLACK BELT


 


 


 


SPARRING  



1st/2nd/3rd places awarded in Black Belt events, regardless of bracket sizes. 6 categories of Grand Champion awarded to Black Belts - Junior Male & Female (up to age 17), Adult Male & Female (ages 18 – 35), Senior Male & Female (ages 36+). Must compete in all three categories: patterns, power breaking, and sparring to be eligible for Grand Champion


SPARRING ITF Rules - 2 Minute Continuous Sparring (headgear & closed finger gloves mandatory); Black Belt 1st/2ndplace = 2/2 minute rounds. 


 



 PATTERNS



ITF Patterns Only; Color Belts 1 optional pattern;


Black Belts 1 optional and 1 designated pattern


 



 POWER BREAKING



 Side Kick (Standing/Skipping/Jumping) and Knife Hand Strike (Inward or Outward) Only



SPEED KICKING


CHON-JI CHALLENGE


FLY OVER KICKING


BANDANA SPARRING



Speed Kicking available for all color belt competitors up to 12 years old and Special Needs competitors.


Chon-Ji Challenge – 1 event for Color Belts & 1 event for Black Belts.


Fly Over Kicking (side kick) available for all color belt competitors ages 13 + regardless of rank & all Black Belts.


Bandana Sparring (1 minute rounds) available to all Color Belts up to age 8.   



HOTEL RECOMMENDATION



 Courtyard Marriott 3 Community Circle Dr. Midlothian, TX


 



 


June 26, 2021
June 25, 2021 11:00pm [Central Time]
Poteet Martial Arts
1080 Dividend Street
Midlothian, TX 76065
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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


Billing information


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*POTEETMARTIALARTS 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
Please enter your full name in the space below.
 


Please click the button below to finalize your registration.



Registration inquiries:
Annette Poteet
poteet.posse@gmail.com
(469) 337-6295
1080 Dividend Street
Midlothian, TX
76065 USA
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Patterns (ITF Patterns only)
Breaking (Foot/Hand)
Most Kicks (Color Belts up to 12 years old and Special Needs only)
Sparring (ITF Continuous Sparring Rules Headgear and closed finger gloves required)
Fly Over Kicking (Ages 13 + and Black Belts only)
Chon-Ji Challenge (Color Belt)
Chon-Ji Challenge (Black Belt)
Bandana Sparring (Color Belts up to 8 years old and Special Needs Only)
Adult XS
Adult Small
Adult Medium
Adult Large
Adult XL
Adult XXL ($2 more)
Adult XXXL ($2 more)
None
Release of Liability: In consideration of your acceptance of my entry, I do hereby, for myself, my heirs, executors, and administrators, waive, release and forever discharge any and all rights and claims for damages which I may have or which may hereafter accrue to me against Poteet Martial Arts and Fitness Center (PMAFC), the tournament directors, all members of the tournament committee or their respective officers, agents, representatives, successors, and/or assigns the tournament participants, judges and staff, for any and all damages which may arise from my traveling to, participating in and returning from such athletic meet. I further agree to waive claims against any persons connected with PMAFC, for any injuries I may sustain and likewise assume full responsibility for all my actions in connection with said tournament.

I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. I further acknowledge that Poteet Martial Arts (PMA) have put in place preventative measures to reduce the spread of the Coronavirus/COVID-19. I further acknowledge that PMA cannot guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to instructors, participants, and their attending families. I acknowledge that I must comply with all set procedures to reduce the spread while attending this event.
I attest that:
* I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.
* I have not traveled internationally within the last 14 days.
* I have not traveled to a highly impacted area within the United States of America in the last 14 days.
* I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.
* I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non-contagious by state or local public health authorities.
* I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.
I hereby release and agree to hold ITF America, ITF and PMA harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of PMA, or that may otherwise arise in any way in connection with this event at Poteet Martial Arts. I understand that this release discharges PMA from any liability or claim that I, my heirs, or any personal representatives may have against the salon with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from PMA. This liability waiver and release extends to the salon together with all owners, partners, and employees. This waiver is in affect for the 8th Annual Line Star Invitational Tournament at Poteet Martial Arts 6/26/2021.

I further agree that any pictures taken of or by me/my child in connection with this event may be used for publicity or promotion without compensation at this time or any other time.
Check this box to indicate that you have read and agree to all of the above terms & conditions