State Champs 2024 – Tasmanian Entries

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Lauderdale Primary School,
3 Acton Road, Lauderdale TAS 7021

Sunday 24th November 2024

Competitor Check-in: 10.00am

Events Begin: 10.30am

COST: $35 First Event, $20 for each Subsequent Event

NO ENTRIES WILL BE ACCEPTED ON THE DAY
All fees are strictly non-refundable.

Spectators (payable at entry): Adults $12, Children $6, Family (2 adults & 2 children) $30 (children under 5 yrs free)

Entries CLOSE SUNDAY 10th November 2024

Entry Qualifications

All Tasmanian GKR Karate students are invited to enter the TAS State Titles.

Additional Tee's*
Competitor Details:
First name*
Last name*
Phone number*
Address line 1*
Address line 2
Address line 3
Town/City*
State*
Postcode*
Competitor information:
Region Number*
Dojo Location (suburb or city)
Age at time of competition*
Age group*
Sex*
Your grade*
Grade division*
*14 - 17 yrs Black Belts MUST enter Junior Open Division
**18 - 34 yrs Black Belts MUST enter Open Division
Which events are you entering?*
- Individual Kata
- Individual Kumite
- Both Individual Kata and Individual Kumite
- Entering Team Kata? (3 to a team)
- Entering Team Kumite (3 to a team)
Team Kata Age and Division*
Team Kata competitor two*
First Last
Team Kata competitor three*
First Last
Team Kumite Age and Division*
Team Kumite competitor two*
First Last
Team Kumite competitor three*
First Last
Please check the boxes below if any of these statements are true:
- Do you have any allergies? e.g. aspirin, antibiotics, foods?
- Have you been in contact with any contagious diseases in the last 3 months?
- Are you taking any form of medication at present?
If the answer is yes to any of the above questions, please give details here:
Doctor's details:
Doctors name*
Doctors phone number*
Doctors address*
Emergency Contact Details:
Contact one name*
Contact one relationship*
Contact one phone number*
Contact one alt. number*
Contact two name*
Contact two relationship*
Contact two phone number*
Contact two alt. number*
Please select...*
I confirm that my child will be attending the tournament with:
Parent/Guardian's Name
Declaration*
- By checking this box, you are agreeing to the Terms and Conditions.
Subtotal
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