SANCTION #: XX-XX-XX
CLINIC TIME/DATE: 9:00AM– 12:00 PM SUNDAY, JUNE 8, 2025
SITE: Boys & Girls Club Judo , 1704 Waioli Street
ELIGIBILITY: Current USJF/USJA/USA Judo Membership. Participant must present Membership card at clinic.
COST: $10 for USJF/USJA/USA Judo Members.
REGISTRATION: Register and pay on-line at: https://www.judoblackbeltassociationofhawaii.com/event/nage-no-kata-clinic-sunday-june-8-2025/#tribe-tickets__tickets-form or email attached forms to. ghashiro@hawaii.rr.com and pay at the clinic. Deadline to register is Thursday June 5.
CONTACT: Gary Hashiro (808) 721-5881
UNITED STATES JUDO FEDERATION
Medical Committee
Mailing Address: Telephone: FAX: Internet:
PO Box 338 (541) 889-8753 (541) 889-5836 www.usjf.com
Ontario, OR 97914-0338
USJF Medical Committee – COVID Update 10/2022
Effective immediately, the following shall apply to all USJF Dojos and all USJF events, local and national:
Testing:
and/or appropriate government entities.
protocols as required by the US State Department/CDC.
Vaccinations:
COVID-19 vaccines are highly encouraged.
Masking:
Masking should follow local/state health department guidelines There is no masking requirement from the USJF national office
Hygiene:
Returning to Activity after COVID Infection:
Members who require hospitalization or experience new or prolonged cardiopulmonary symptoms should consult with their personal physician BEFORE returning to activity
If you have any questions or concerns, please consult your personal physician
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 (“Activity”) of the United States Judo Federation, Inc., Judo Black Belt
Association of Hawaii, Inc., Hawaii Boys & Girls Club Judo, Boys & Girls Club of Hawaii, and the officers,
employees, volunteers, and agents, I agree:
rules governing the sport of Judo.
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.
disease, including permanent disability or death, 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, including United States Judo Federation, together with
their affiliated clubs, their respective administrators, directors, officers, agents, coaches, and other employees or volunteers of the
organization, event officials, medical personnel, other participants, their parents, legal guardians, supervisors and coaches,
sponsoring agencies, sponsors, advertisers, and if applicable, owners, lessors, and lessees of premises used in conducting the
event (Releasees), 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 me or not reasonably foreseeable at this time.
damages following such injury, illness, disease, permanent disability, or death.
Belt Association of Hawaii, Inc., Hawaii Boys & Girls Club Judo, and the Boys & Girls Club of Hawaii, together
with their affiliated clubs, their respective administrators, directors, officers, agents, coaches, and other employees or volunteers
of the organization, event officials, medical personnel, other participants, their parents, legal 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 litigation expenses, attorney fees, loss, liability,
damage or costs on account of injury, illness, disease, including permanent disability and death or damage to property, caused or
alleged to be caused in whole or in part by the negligent acts or omissions of the Releasees or otherwise to the fullest extent
permitted by law.
I HAVE READ THE ABOVE WARNING, WAIVER, AND RELEASE, UNDERSTAND THAT I HAVE
GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND KNOWING THIS, SIGN IT VOLUNTARILY
AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE. 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/LEGAL
GUARDIAN AS EVIDENCED BY THEIR SIGNATURE BELOW. I INTEND THIS TO BE A COMPLETE
AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED
BY LA W AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID
THAT THE BALANCE, NOTWITHSTANDING SHALL CONTINUE IN FULL FORCE AND EFFECT.
__________________________________ ______________________________ _________________
Participant Participant’s Signature Date
FOR PARENTS/LEGAL GUARDIANS OF PARTICIPANTS OF MINORITY AGE(UNDER AGE 18 AT TIME OF REGISTRATION)
This is to certify that I, as parent/legal 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 child’s involvement
or participation including litigation expenses, attorney fees, loss, liability, damage or costs which may incur as the result
of the minor child’s 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.
__________________________________ ______________________________ _______________
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2025-06-08 JBBAH Nage no Kata Clinic Registration Packet Draft