Grapplers Domain

Name: _________________________________School: _________________________Instructo= r: _______________________

Address: ______________________________________City: _____________________State: _________ Zip: _____________

Birth Date: __________________Phon= e: ___________________________Email: ____________________________________=

Adult Division: (154 and under)<= span style=3D'mso-spacerun:yes'> (155-165) (166-175) (176-185) (186-195) (196-205) (206-225) (226 AND UP)

= ; &n= bsp; = ;

= &nb= sp; _____ Beginner (18 mos. or less) = _____ Advanced (18 mos. or more)

= ; &n= bsp; = ; &n= bsp;

= &nb= sp; = = &nb= sp; **** NHB Experience has nothing to do with Grappling Tournaments****<= /span>

………………………R= 30;…………………………&#= 8230;…………………………= …………………………̷= 0;……………………

Men’s Open: No weight class = _____ Beginner &nbs= p; _____ Advanced

********************* Brackets are subject to co= mbine depending on entries *******************

Children’s Division: = Weight: _______LBS

(50 AND UNDER) (51-60= ) (61-70) (71-80) (81-90) (91-100) (101-110) (111-120) (121-130) (131-145)

= &nb= sp; = (146-160) (161-175) (176-190) (191-205) (206-215) (216-225) = (226 AND UP)

= ; &n= bsp; = ; ______Beginner (under 18 months) = ______ Advanced (18 months or more)

………………………R= 30;…………………………&#= 8230;…………………………= …………..………………= 230;…………………..

Children’s Open:<= span style=3D'font-size:10.0pt'> Brackets are based on weight only; not age or experience.=

= &nb= sp; _____ 70 lbs and under = _____71 lbs -100 lbs = &nb= sp; ____ 101 l= bs and up =

= &nb= sp; = &nb= sp; = &nb= sp;

Tournament Release and Waiver

(By finalizing this application, you agree to the terms listed below)

I hereby waive all claims against a= ny and all persons associated with any of the participating schools and competitors. I understand the= rules of the tournament and will abide by them. I understand that I am participat= ing in a sport that usually has body contact.&= nbsp; I assume full responsibility for all my actions during and connected= to the above tournament to include any vandalism to any items or of the buildi= ng it self. I understand the risk of competing in this form of Martial Arts competition and hereby release Hybrid Combat Mixed Martial Arts and the eve= nt known as Grapplers Domain, and all of its employee’s, workers, volunteers, and associates, tournament sponsors, Hosted Venue, and Aaron Pendleton, from any type of injury, loss, dismemberment, or death sustained while competing in this competition. I also state tha= t I am good physical condition and know of no reason why I should not compete in t= his tournament. I have current and valid health insurance. I understand that divisions and we= ight classes are subject to change. I understand that Hybrid Combat does not offer refunds. In case of emergency, I hereby aut= horize any licensed medical personal to perform any accepted medical treatment dee= med necessary and I agree to bare the expense of any such treatment. I also agr= ee that my attendance and /or performance at the tournament may be photographe= d, filmed, or taped and used by any schools competitors, or spectators and/or Hybrid Combat Mixed Martial Arts and I waive any compensation thereof. I ha= ve read the rules and the release above and agree to all of its terms and enter this application to complete this form.

___________________________________= _____ = &nb= sp; _____________________________________ = &nb= sp; = __________________

Signature &nb= sp; = &nb= sp; = &nb= sp; = &nb= sp; = Parent/Guardian (if under 18) &= nbsp; &nbs= p; &= nbsp; = &nb= sp; = Date