Twenty Eighth Annual Liberty Bell Developmental Tournament

DATE:

Sunday January 25, 2015

PLACE:

Liberty Bell Georgian Judo Academy 83 Bustleton Pike Feasterville Pa 19053 Directions on entry
form

ELIGIBILITY:

Any judoka ages 5 to adult who has a current 2014 - 2015 membership card

SANCTIONED BY:

USA Judo

ENTRY FEE:

$ 35.00 IF RECEIVED BY THURSDAY 1/24

$ 45.00 late registration the day of competition
Second divisions fee $15.00 third division $10.00

AWARDS:

1st, 2nd, and, 3rd Place Medals in each division

SYSTEM:

Modified double elimination or 3/4 man pools

RULES:

IJF will govern: Modified rules may apply. Old out of bound rules will be used. No armlocks in the 1316 age group and senior novice divisions. Shido will be given to under 12 year old athletes who grap
legs.

DIVISIONS:

Juniors: Boys and Girls ages 5/6 7-9, 10-12, 13-16

5 or more divisions in each category for boys
3 or more divisions in each category for girls
Seniors: White and brown belts only
Female - 3 or more divisions
Male - 5 or more divisions
Masters: Male and female, all ranks, ages 30 and over
Divisions to be determined by number of competitors

INFORMATION:

Louis Moyerman: (215) 313-2098

Anatoliy Kenis: (215) 469-0342
Email: lmoyerman@aol.com or akenis@gmail.com

REGISTRATION
AND
WEIGH - INS:

Boys & Girls ages 5 -12: 8:30 - 9:15

Boys, & Girls ages 13-16, Masters and Senior male/female:
12:00 12:45

SPECIAL NOTE:

Competition will be split into separate novice divisions for juniors and
seniors if possible. All juniors will receive a medal.

th

DATES FOR LIBERTY BELL CLASSIC: Saturday March 28 2015

ENTRY FORM
ENCLOSED $35.00 REGISTRATION FEE $45.00 LATE FEE (after 1/24)
Second division fee $15.00 third division fee $10.00
Make checks payable to Liberty Bell Judo and mail to:
LBGJA 83 Bustleton Pike Feasterville Pa 19053
Name________________________________________________ Age ___________ Sex _____
Address ____________________________________ City _____________ St ____ Zip _______
Usji, Usja, Usjf # ____________Exp _________ Club _________________Rank ____________
Check Division and circle age category:
______ Boys

5/6

7-9

10-12

13-16

______ Girls

5/6

7-9

10-12

13-16

______ Senior Male

White

Brown

______ Senior Female

White

Brown

______ Masters

Male

Female
NO REFUNDS

NO PHONE ENTRIES

IT IS MANDATORY THAT THE ENCLOSED LIABILITY WAIVER BE SIGNED TO COMPETE.

th

DATES FOR LIBERTY BELL CLASSIC: Saturday March 28 , 2015

Directions to the Club:
The judo club is located at 83 Bustleton Pike (between County Line Road and Street Road).
FROM THE PA TURNPIKE: Exit at the Bensalem exit and follow Route 1 South. Just off the exit turn right onto Street Road
(Route 132 West). Follow directions from Street Road (below).
FROM US95: Exit Street Road (Route 132) West. Follow directions from Street Road (below).
FROM: US Route 1 Roosevelt Blvd travelling north. Turn left onto Red Lion Rd. follow to Buselton Ave and turn right. Follow
about 3 to 4 miles passing County Line Road. The dojo is on the right just past Bottom Dollar.
FROM STREET ROAD (going West): turn left onto Bustleton Pike, follow approximately 2 miles judo club is on the left.
Please park across the street from the club and walk carefully over to the dojo. There is limited parking in front of
the club but on Sunday parking across the street works for everyone.

WARNING!
WAIVER AND RELEASE OF LIABILITY AND AGREEMENT TO PARTICIPATE
In consideration of being permitted to participate in any way, including travel to and from, in any Judo tournament, practice,
clinic, and related events and activities of the United States Judo Federation, Inc., USA Judo, Inc., United States Judo
Association, Inc., Shufu Judo Yudanshakai, Liberty Bell Judo Inc., Liberty Bell Georgian Judo Academy, 83BK llc 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 conditions 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, traumatic brain injury (TBI) and severe social and economic losses due not only to
my own actions, inactions or negligence, but also to 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 file or not reasonably foreseeable at this time.
4. Knowing the risks involved in the sport of Judo, I assume all such risks and accept personal 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, Liberty Bell Judo Inc., Liberty Bell Judo &
Georgian Judo Academy 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 and coaches, sponsoring agencies, sponsors, advertisers, and if applicable, owners, lessors, and lessees
of premises used in 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 law.
________________________________________ _________________________________________ ________________
1 HAVE READ THE ABOVE WARNING, WAIVER, AND RELEASE, UNDERSTAND THAT I GIVE UP
SUBSTANTIAL RIGHTS BY SIGNING IT, AND KNOWING THIS, SIGN IT VOLUNTARILY. I AGREE TO
PARTICIPATE KNOWING THE RISKS 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
Participants Signature
Date
FOR PARENTS/GUARDIANS OF PARTICIPANTS 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 childs 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 as to the above warnings and conditions and their ramifications.
________________________________________ _________________________________________ ________________

Parent/Guardian

Parent/Guardians Signature

Date