Parks and Recreation, Central Area
&
Development Clinics for
Referees & Technical Officials
Sanctioned by Maryland Judo, Inc., Sanction #705
Clinic Director: Edwin Y. Takemori, Shichidan, National
Referee, National Coach, Tournament
Director
for over 30 years
Date: Saturday, August 11, 2007
Location:
Glenn
Registration: 8:30 –
9:00 AM
Fee: $ 20.00 for Referee
$10.00 for Technical
Officials Clinic
Note: USJF/USJA/USJI
Cards must be presented at registration
Clinicians:
Referee Clinic: Roy Englert, Godan, IJF Referee,
Technical
Officials: Greg Goebel, Sandan, Chair,
MJI Technical Official Committee
Eligibility and who should come:
Referee
Clinic: This clinic is for regional,
national or higher referees. Local referees who have refereed for several years
and are preparing to take the regional exam should attend this clinic. ‘
USJF/JI/JA membership required
Technical
Officials:
Parents, injured judoka, friends, family; Anyone
interested in learning the finer points of how to score a judo match. Both
manual scoring and various electronic systems will be covered. USJF/JI/JA
membership NOT required; anyone may attend.
Schedule:
Registration: 8:30am to 9:00 am
Break for lunch noon to 1:00 pm
James Burrell Team Tournament 1:00 pm to 3:00pm
Break back down into groups for feedback
3:00 pm to no later than 4:30pm
For Additional
Information Contact:
Edwin Y. Takemori, at Takemorijudo@cs.com or 410/431-7360
Helen McProuty, at Hmcprouty@earthlink.net or 301/262-0762
Emergency phone contact on clinic day: 202-262-7218
Directions:
FROM 95/495 - THE BELTWAY:
From the
Beltway, take exit 20 - Route 450 east towards Lanham. Watch directional signs
and stay on 450 east (towards
FROM ROUTE 50 WEST: (
Take exit 197 north towards
FROM THE
Take the exit for Route 193/Greenbelt
Road. At the stop sign turn left. At the light turn left onto
HOTEL INFORMATION
1. Best Western--
2. Holiday Inn
3. Days Inn - Lanham Station --9023
Clinic Entry Form
Please check the clinic you are registering for and
your level of involvement.
Referee Clinic:
Regional Referee National Referee Higher Referee
Technical
Official Clinic: Experienced Scorer New
to Scoring
Name: ___________________________________________________________
Home Address: ____________________________________________________
City:
Phone Number: (H) ______-______-__________ (W) ______-______-__________
Email: _______________________________________________________________
Age: ______ Date of birth: ____/____/________ Sex: M F
Club Name: __________________________________________________________________
USJI/USJF/USJA Number(Circle One): ___________________ Expiration Date: ____/____/____
NOTE: New and Renewal applications will be taken on site.
Rank: ____________________
Payment may be made by:
CHECK or MONEY ORDER payable to M-NCPPC.
Enclosed is a Check or Money Order for $_____________________.
Driver’s
License Number:
CREDIT CARD (Visa or Master Card Only).
Card Number: _______________________________________________________ Exp. ___________
Please mail the completed entry form, waiver and payment to:
You MUST read and sign the waiver.
Entries will not be accepted without a signed waiver.
WARNING!
WAIVER
AND RELEASE OF LIABILITY AND AGREEMENT TO PARTICIPATE
In consideration of being permitted to participate in anyway, including
travel to and from, in any judo tournament, practice, clinic and other related
event and activities of the United
States Judo Federation Inc., United States Judo, Inc., United States Judo
Association, Inc., Shufu Judo Yudanshakai,
Maryland Judo Inc., Maryland-National Capitol Park and Planning Commission, Glenn
Dale Community Center, and the Prince George’s Judo Club, I hereby:
1. Acknowledge that I am familiar with the sport
of Judo and understand the rules governing the sport of Judo.
2. Agree
that, prior to participating, I will inspect the mats, equipment, facilities,
competition pools or
divisions, and the elimination or scoring system to
be used, and if I believe anything is unsafe or beyond my capability, I will
immediately advise my coach, supervisor, and/or a tournament official of such
condition and refuse to participate.
3. Acknowledge and fully understand that I will
be engaging in a contact sport that might result in serious injury, including
permanent disability or death, and severe social and economic losses due to not
only my own actions, inactions, or negligence, but also the actions, inactions,
or negligence of others, the rules of the sport of Judo, or conditions of the
premises or of any equipment used. Further, I acknowledge that there may be
other risks not known to me or not reasonably foreseeable at this time.
4. Knowing the risks in the sport of Judo, I
assume all such risks and accept personnel responsibility for the damages
following such injury, permanent disability, or death.
5. Release,
waive, discharge and covenant not to sue the United States Judo Federation Inc., United
States Judo Inc., United States Judo Association Inc., Shufu
Judo Yudanshakai, Maryland Judo Inc.,
Maryland-National Capitol Park and Planning Commission, Glenn Dale Community
Center, and the Prince George’s Judo Club, together with their affiliated clubs, their
respective administrators, directors, agents, coaches, and other employees or
volunteers of the organization, event officials, medical personnel, other
participants, their parents, guardians, supervisors, coaches, sponsoring
agencies, sponsors, advertisers, and if applicable, owners, lessors,
lessees of the premises used to conducting the event, all of whom are
hereinafter referred to as "Releasees",
from any and all claims, demands, losses, or damages on account of injury,
including permanent disability and death or damage to property, caused or
alleged to be caused in whole or in part by the negligence of the Releasees or otherwise to the fullest extent permitted by
the law.
I HAVE READ THE ABOVE WARNING, WAIVER, AND RELEASE, UNDERSTAND THAT IF I GIVE UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND KNOWING THIS, SIGN IT VOLUNTARILY. I AGREE TO PARTICIPATE KNOWING THE RISK AND CONDITIONS INVOLVED AND DO SO ENTIRELY OF MY OWN FREE WILL. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENT/GUARDIAN AS EVIDENCED BY THEIR SIGNATURE BELOW.
_____________________________ ____________________________ _____________
Participant
Participant’s
Signature Date
FOR
PARENTS/GUARDIANS OF PARTICPANTS OF MINORITY AGE
(UNDER AGE 18
AT TIME OF REGISTRATION
This
is to certify that I, as parent/guardian with legal responsibility for this
participant, do consent and agree to his /her release, as provided above, of
all the Releasees, and, for myself, my heirs, assigns
and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor
child’s involvement or participation in these programs as provided above, even
if arising from their negligence, to the fullest extent permitted by law. I
have instructed the minor participant to the above warnings and conditions and
their ramifications.
___________________________ ______________________________ _____________
Parent/Guardian Parent/Guardian’s
Signature Date
U.S. Judo Association, U.S. Judo Federation, Inc., U.S. Judo, Inc. © February 1998