2025 MKA NSW State ChAmpionships

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth *

MM

DD

YYYY

Instructor's Name *

First Name

Last Name

Events I am entering

Tick appropriate Boxes

Full Contact

Non Contact

Children's Padded

Declaration *

1. In participating in this event, I understand the risk of harm (including personal injury or death, damage to property or economic loss) 2. I release and waive all liability in respect of this event (or its agents, employees or contractors), that may otherwise have arisen as a result of my participation in the tournament. 3. I understand that this event (or its agents, employees or contacts) will not be liable for the cost of treatment of any injuries that may be sustained as a result of participating. 4. By participating in this event and during this event, I agree that I become a member of MKA for this event only and agree to obey by the rules of the tournament. 5. Adults: a doctor's certificate stating the applicant is fit to participate in a full-contact tournament must be produced on the day of the event and must not be more that 4 weeks old.

Consent *

The entrant has completed this form or if the applicant is under 18 years of age the application has been submitted by the guardian. By checking this box, the entrant or legal guardian has completed this form and consents to the participant's entry to this event.

Name of person filling this form *

Parent or Guardian if under 18 or entrant if over 18

First Name

Last Name