ORGANIZED BY : NADIA DISTRICT SPORTS KARATE-DO ASSOCIATION (Govt. regd.

)
AFFILIATED TO : KARATE-DO ASSOCIATION OF BENGAL(K.A.B.)
K.A.B. AFFILIATED TO : KARATE INDIA ORGANIZATION(K.I.O.),
BENGAL OLYMPIC ASSOCIATON
K.I.O. AFFILIATED TO : WORLD KARATE FEDERATION (W.K.F.)

NAME OF PARTICIPANTS…………………………………………………………………………………………………………………… PHOTO

GUARDIAN’S NAME ……………………………………………………………………………………….....................................

ADDRESS …………………………………………………………………………………....................................................................................

DATE OF BIRTH ……………………………………………………………… AGE ………………………... SEX …………… WEIGHT……………………..

MOBILE NO : …………………………………………………………………………….., STYLE NAME …………………………………………………………

INSTRUCTOR’S NAME…………………………………………………………………………………………….ENTRY FEES…………………………………

EVENT NO : KATA KUMITE TEAM KATA K.A.B. ID NO

RELEASE : I , Undersigned, do hereby voluntarily submit my application in the “ 9TH NADIA DISTRICT KARATE CHAPIONSHIP 2024 &
SELECTON FOR KAB STATE SELECTION FOR KIO NATIONAL” on 31st March 2024 and hereby assume full responsibility for any and all
damages, injuries or losses that may sustain or incur if any , while participating or attending and hereby waive all claims against the
promoters, operators sponsors , judges , officials ,opponents & their families. Individually or otherwise , for any claim for injuries
that I may sustain . I fully understand that karate is a body contact sport and that any medical treatment given to me will be of a
first aid only. I further submit that I am in good physical condition to participate in this event.

RULES & REGULATIONS

 Any kata may be performed by the competitor. Tournament will be conducted as per WKF & KIO rules.
 Xerox copy of the Aadhar Card has to be attached to the tournament form.
 Tournament committee shall provide only the first-aid to the competitor.
 Entry FEES : SINGLE EVENT : 1000/- DOUBLE EVENT : 1400 /- (once fees paid shall not be refunded.)
 TEAM KATA ENTRY FEES 1000 /- (once fees paid shall not be refunded.)
 1 gold, 1 silver, 2 bronze medals in each category along with the merit certificate will be awarded to the
winners.
 All players should be in Clean karate uniform, complete set of their own protective guards and belts.
(only KIO & WKF Approved protective equipments are allowed.
 Last date of depositing form is 25.03.2024.after that no form will be accepted.

COMPITITOR’S SIGNATURE GAURDIAN’S SIGNATURE INSTRUCTOR’S SIGNATURE STYLE HEAD

 ORGANIZED BY : NADIA DISTRICT SPORTS KARATE-DO ASSOCIATION (Govt. regd.)
AFFILIATED TO : KARATE-DO ASSOCIATION OF BENGAL(K.A.B.)
K.A.B. AFFILIATED TO : KARATE INDIA ORGANIZATION(K.I.O.),
BENGAL OLYMPIC ASSOCIATON
K.I.O. AFFILIATED TO : WORLD KARATE FEDERATION (W.K.F.)

WRONG WEIGHT & AGE INFORMATION PROVED THE COMPITITOR SHOULD BE DISQUALIFIED
FROM THE EVENT.