2018 Las Vegas Open International Taekwondo Championship - Team USA
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2018 Las Vegas Open International Taekwondo Championship
July 12, 2018
Dear Athletes, Coaches, and all Taekwondo Educational Establishments:
It is with great pleasure that we are inviting to the 9th “Las Vegas Open
International Tae Kwon Do Championship.”
The tournament will be held in peace and harmony on November 17, 2018 at the
LVH Hotel and Casino in Las Vegas Nevada, USA.
As you know, Tae Kwon Do is one of the popular sports that represent Korea.
Through this respectful sport, we make a difference in our world. The members of
my organization, as well as the city of Las Vegas, will do our best to make sure
the tournament is organized. We will provide every amenity possible during your
stay with us. We are sure that you will receive our warmest hospitality and
great memories in Las Vegas. I would like to personally thank you again for your
devotion to Tae Kwon Do and your participation in this event.
We sincerely look forward to seeing you in Las Vegas.
My best regards,
Grandmaster George A. Tapia
grandmastertapia@gmail.com
www.gaitftaekwondo.org
702-682-7523
LODGING
West Gate Hotel & Casino
Las Vegas Open International Taekwondo Championship has arranged for a group
single or doubles at the West Gate Hotel and Casino.
In order to get this offer mention Las Vegas Open
Here is LVH Hotel’s exclusive link to the resort to make you reservation:
https://aws.passkey.com/go/SLV87R
West Gate Hotel & Casino
3000 Paradise Rd
Las Vegas NV, 89109
Phone (702)732-5111 (800) 732-7117 www.thelvh.com
Athletes- Coaches and Referees Event Registration Direct Line:
www.usat.hangastar.com
1.DATE: November 17, 2018 2. VENUE: West Gate Hotel & Casino - 3000 Paradise Road, Las Vegas, NV 89109 3. PREREQUISITES: MEMBERSHIP All participants, athletes and coaches, must be current 2018 USA Taekwondo members. Membership can be easily renewed through your Hang-a-star profile. If you need to become a new member of USA Taekwondo please see the membership portion of our website at http://usa-taekwondo.us COACHING EDUCATION The minimum level of coaching education to register for the Las Vegas Open International Taekwondo Championship is the Associate level. For more information on obtaining this level of certification please visit http://usa-taekwondo.us/pages/5597.
4. COMPETITION RULES:
USA Taekwondo’s Competition Rules
http://assets.teamusa.org/assets/documents/attached_file/filename/20233/USAT_Rules_REVIS
E_Jan_6_10.pdf
6-13 year old divisions will use the junior safety rules for sparring
http://assets.teamusa.org/assets/documents/attached_file/filename/20237/12_9_Junior_Comp
etition_Rules.pdf
5. EQUIPMENT:
Las Vegas Open International Taekwondo Championship will be using DAEDO TRUESCORE at this
event and will be supplying the electronic chest gear. All Color belts of any age must use
DAEDO socks. These can be purchased by visiting http://www.truescore.com or by visiting
the DAEDO representatives at the event.
All athletes will be responsible for supplying their own headgear, gloves, foot pads, arm and
shin guards, mouth guards and all necessary athletic taping.
All color belts will use G1
All Black Belts will use G2 and electronic headgear
Ages 13 & up color belts will use electronic headgear
6. REGISTRATION DATES:
Online registration can be made at www.usat.hangastar.com
Early registration ends November 10, 2018 at 11:59pm MST
Late registration ends November 13, 2018 at 11:59 pm MST7. REGISTRATION PRICES
Please note that all registration fees are non-refundable. Also, if the payment is
not made in full by the early
Competition
Division Early Registration Late Registration
November 10, 2018 November 13, 2018
online paper online
1 Event $ 100 $ 120
Each additional Event $ 10 $ 20
COACHES EARLY LATE
All coaches must be REGISTRATION REGISTRATION
USAT certified November 10, 2018 November 13, 2018
Online Online Paper
COACHES $30 $608. SPECTATOR TICKET PRICES:
SINGLE DAY PASS
All Tickets $10.00
Kids (5 & Under ) $ 5.00
9. WEIGHT DIVISIONS & COMPETITION FORMAT:
2018 – FEMALE SPARRING AGE DIVISIONS AND WEIGHT CATEGORIESMATCH TIME LIMITS
ALL MATCH 30 SEC REST WEIGHT
AGE CLASSES AGE DIVISIONS BELT COLOR ROUND – TIME CATEGORY (Kg) WEIGHT CLASSES
#DRAGONS 6-7 YEARS OLD YELLOW, GREEN,BLUE, 2 ROUND – 1 MIN U19, U23,U27 & O27 FIN LIGHT, MIDDLE, HEAVY
RED, BLACK
#TIGERS 8-9 YEARS OLD YELLOW, GREEN,BLUE, 2 ROUND – 1 MIN U21, U25, U30 &O30 FIN LIGHT, MIDDLE, HEAVY
RED, BLACK
YOUTH 10-11 YEARS OLD YELLOW, GREEN,BLUE, 2 ROUND – 1 MIN U30, U35, U40 & O40 FIN LIGHT, MIDDLE, HEAVY
RED, BLACK
CADET 12-14 YEARS OLD YELLOW, GREEN,BLUE, 2 ROUND – 1 MIN U33,U37, U43, U48 & O48 FIN, BANTAM, LIGHT,
RED MIDDLE, HEAVY
CADET 12-14 YEARS OLD BLACK 3 ROUND – 1.5 MIN U29, U33,U37, U42, U44, FIN, FLY, BANTAM,
U47, U51, U59, O59 FEATHER, LIGHT, MIDDLE,
WELTER, LT MIDDLE,
MIDDLE, LT HEAVY, HEAVY
JUNIOR 15-17 YEARS OLD YELLOW, GREEN,BLUE, 2 ROUND – 1 MIN U42, U44, U46, U49, U52, FIN, FLY, BANTAM,
RED U55, U59, U63, U68 & O68 FEATHER, LIGHT, MIDDLE,
WELTER, LT MIDDLE,
MIDDLE, LT HEAVY, HEAVY
JUNIOR 15-17 YEARS OLD BLACK 3 ROUND – 1.5 MIN U42, U44, U46, U49, U52, FIN, FLY, BANTAM,
U55, U59, U63, U68 & O68 FEATHER, LIGHT, MIDDLE,
WELTER, LT MIDDLE,
MIDDLE, LT HEAVY, HEAVY
SENIOR 18-32 YEARS OLD YELLOW, GREEN,BLUE, 3 ROUND – 1 MIN U51, U59, U67, O67 FIN LIGHT, MIDDLE, HEAVY
RED
SENIOR 18-32 YEARS OLD BLACK 3 ROUND – 1. MIN U46, U49, U53, U57, U62, FIN, FLY, BANTAM, LIGHT,
U67, U73 & O73 WELTER, MIDDLE, HEAVY
ULTRA 33+ YEARS OLD YELLOW, GREEN,BLUE, 3 ROUND – 1 MIN U49 U57, U67 &O67 FIN LIGHT, MIDDLE, HEAVY
RED, BLACK10. 2017 – MALE SPARRING AGE DIVISIONS AND WEIGHT CATEGORIES
MATCH TIME LIMITS
ALL MATCH 30 SEC REST
WEIGHT
AGE CLASSES AGE DIVISIONS BELT COLOR ROUND – TIME CATEGORY (Kg) WEIGHT CLASSES
#DRAGONS 6-7 YEARS OLD YELLOW, GREEN,BLUE, 2 ROUND – 1 MIN U19,U23,U27 & O27 FIN LIGHT, MIDDLE,
RED, BLACK HEAVY
#TIGERS 8-9 YEARS OLD YELLOW, GREEN,BLUE, 2 ROUND – 1 MIN U21, U25, U30 & O30 FIN LIGHT, MIDDLE,
RED, BLACK HEAVY
YOUTH 10-11 YEARS OLD YELLOW, GREEN,BLUE, 2 ROUND – 1 MIN U30, U35, U40 & O40 FIN LIGHT, MIDDLE,
RED, BLACK HEAVY
CADET 12-14 YEARS OLD YELLOW, GREEN,BLUE, 2 ROUND – 1 MIN U34, U40, U45, U50, & O50 FIN, BANTAM, LIGHT,
RED MIDDLE, HEAVY
CADET 12-14 YEARS OLD BLACK 3 ROUND – 1.5 MIN U33, U37, U41, U45, U49, FIN, FLY, BANTAM,
U53, U57, U61, U65 &O65 FEATHER, LIGHT, MIDDLE,
WELTER, LT MIDDLE,
MIDDLE, LT HEAVY,
HEAVY
JUNIOR 15-17 YEARS OLD YELLOW, 2 ROUND – 1 MIN U45, U48, U51, U55, U59, FIN, FLY, BANTAM,
GREEN,BLUE,RED U63, U68, U73, U78 & O78 FEATHER, LIGHT, MIDDLE,
WELTER, LT MIDDLE,
MIDDLE, LT HEAVY,
HEAVY
JUNIOR 15-17 YEARS OLD BLACK 3 ROUND – 1.5 MIN U45, U48, U51, U55, U59, FIN, FLY, BANTAM,
U63, U68, U73, U78 & O78 FEATHER, LIGHT, MIDDLE,
WELTER, LT MIDDLE,
MIDDLE, LT HEAVY,
HEAVY
SENIOR 18-32 YEARS OLD YELLOW, 3 ROUND – 1 MIN U58, U67, U78 & O78 FIN LIGHT, MIDDLE,
GREEN,BLUE,RED HEAVY
SENIOR 18-32 YEARS OLD BLACK 3 ROUND – 2 MIN U54, U58, U63, U68, U74, FIN, FLY, BANTAM, LIGHT,
U80, U87 & O87 WELTER, MIDDLE, HEAVYWTF FORMAT COMPETITION SPORT POOMSAE: The World Taekwondo Federation has developed an International Poomsae competition format that is used in the WTF World Poomsae Championships. The competition consists of Individual, Pairs and Team divisions Black Belts 10 year and older. The Method of Competition starts with preliminary round: When 20 or more contestants are participating; competition shall start From preliminary round. Contestants shall perform the two (2) assigned compulsory Poomsae predetermined by the Tournament Director, the top 50 percent of participants will qualified for the next round. Semi-Final round: When 9-19 contestants are participating; Contestants shall perform the two (2) assigned compulsory Poomsae predetermined by the Tournament Director and eight (8) shall be advanced to final based on their points. Final: When 8 or fewer contestants are participating; competition shall start from final round. Contestants shall perform the two (2) assigned compulsory Poomsae predetermined by the Tournament Director. The ranking of the top tree (3) of each category will be decided by the results of their performance.
INDIVIDUAL Under 17 years old –Individual Male & Individual Female Compulsory Poomsae : Taeguek 4,5,6,7,8,Koryo, Keumgang, Taebaek Under 29 years old & Under 39 years old – Individual Male & Individual Female Compulsory Poomsae : Taeguek 6,7,8,Koryo, Keumgang, Taebaek,Pyonwon,Shipjin Under 49 years old- Individual Male & Individual Female Compulsory Poomsae: Taeguek 8, Koryo, Keumgang, Taebaek, Pyonwon, Shipjin, Jitae, Chonkwon Under 59 years old & Over 59 years old – Individual Male & Individual Female Compulsory Poomsae: Koryo, Keumgang, Taebaek, Pyonwon, Shipjin, Jitae, Chonkwon, Hansu PAIR Under 29 years old (1 male & 1 female) Compulsory Poomsae : Taeguek 6,7,8, Koryo, Keumgang, Taebaek, Pyonwon, Shipjin Over 29 years old ( 1 male & 1 female) Compulsory Poomsae: Taeguek 8, Koryo, Keumgang, Taebaek, Pyonwon, Shipjin, Jitae, Chonkwon TEAM Under 29 years old (3 males & 3 females) Compulsory Poomsae : Taeguek 6,7,8, Koryo, Keumgang, Taebaek, Pyonwon, Shipjin Over 29 years old (3 males & 3 females) Compulsory Poomsae: Taeguek 8, Koryo, Keumgang, Taebaek, Pyonwon, Shipjin, Jitae, Chonkwon
10. INDIVIDUAL POOMSAE
2018 – CO-ED PAIRS AGE DIVISIONS
AGE CLASSES AGE DIVISIONS BELT COLOR RANK COMPETITION
TYPE
#DRAGONS 6-7 YEARS OLD BLACK 1ST – 9TH MODIFIED WTF
FORMAT
#TIGERS 8-9 YEARS OLD BLACK 1ST – 9TH MODIFIED WTF
FORMAT
YOUTH 10-11 YEARS OLD BLACK 1ST – 9TH MODIFIED WTF
FORMAT
CADET 10-14 YEARS OLD BLACK 1ST – 9TH WTF FORMAT
JUNIOR 15-17 YEARS OLD BLACK 1ST – 9TH WTF FORMAT
1ST PAIR 18-29 YEARS OLD BLACK 1ST – 9TH WTF FORMAT
2ND PAIRS 30+ YEARS OLD BLACK 1ST – 9TH WTF FORMAT2018 – INDIVIDUAL POOMSAE AGE DIVISIONS
AGE CLASSES AGE DIVISIONS BELT COLOR RANK
DRAGONS 6-7 YEARS OLD YELLOW, GREEN, BLUE, RED N/A
DRAGONS 6-7 YEARS OLD BLACK 1ST – 9TH
TIGERS 8-9 YEARS OLD YELLOW, GREEN, BLUE, RED N/A
TIGERS 8-9 YEARS OLD BLACK 1ST – 9TH
YOUTH 10-11 YEARS OLD YELLOW, GREEN, BLUE, RED N/A
YOUTH 10-11 YEARS OLD BLACK 1ST – 9TH
CADET 12-14 YEARS OLD YELLOW, GREEN, BLUE, RED N/A
CADET 12-14 YEARS OLD BLACK 1ST– 9TH
JUNIOR 15-17 YEARS OLD YELLOW, GREEN, BLUE, RED N/A
JUNIOR 15-17 YEARS OLD BLACK 1ST – 9TH
1ST SENIOR 18-29 YEARS OLD YELLOW, GREEN, BLUE, RED N/A
1ST SENIOR 18-29 YEARS OLD BLACK 1ST – 9TH
2ND SENIOR 30-39 YEARS OLD YELLOW, GREEN, BLUE, RED N/A
2ND SENIOR 30-39 YEARS OLD BLACK 1ST – 9TH
1ST MASTERS 40-49 YEARS OLD YELLOW, GREEN, BLUE, RED N/A
1ST MASTERS 40-49 YEARS OLD BLACK 1ST – 9TH
2ND MASTERS 50-59 YEARS OLD YELLOW, GREEN, BLUE, RED N/A
2ND MASTERS 50-59 YEARS OLD BLACK 1ST – 9TH
3RD MASTERS 60-69 YEARS OLD YELLOW, GREEN, BLUE, RED N/A
3RD MASTERS 60-69 YEARS OLD BLACK 1ST – 9TH14. Co-ed & Pairs
Males Females
9 and Taeguek 5 Taeguek 4 Taeguek 6 Taeguek 5 Taeguek 4 Taeguek 6
under & &
Taeguek8 Taeguek8
14 and Taeguek 7 Taeguek 5 Taegeuk 6 Taeguek 7 Taeguek 5 Taegeuk 6
under &Keumga &Keumga
ng ng
Junior Taeguek 4 Taeguek 8 Koryo & Taeguek 3 Taeguek 8 Koryo &
15-17 Taegeuk 6 Taegeuk 6
29 and Taeguek 8 Keumgan Pyongwon Taeguek 8 Keumgan Pyongwon
under g & Koryo g & Koryo
2nd Team Keumgan Taebaek Koryo & Keumgan Taebaek Koryo &
30+ g g Pyongwon
Pyongwon2018 TEAM [MALE/FEMALE] POOMSAE AGE DIVISIONS
AGE CLASSES AGE DIVISIONS BELT COLOR RANK
#DRAGONS 6-7 YEARS OLD BLACK 1ST – 9TH
#NINJAS 8-9 YEARS OLD BLACK 1ST – 9TH
YOUTH 10-11 YEARS OLD BLACK 1ST – 9TH
CADET 12-14 YEARS OLD BLACK 1ST – 9TH
JUNIOR 15-17 YEARS OLD BLACK 1ST – 9TH
1ST TEAM 18-29 YEARS OLD BLACK 1ST – 9TH
2ND TEAM 30+ YEARS OLD BLACK 1ST – 9THTeam
Team Males Females
Preliminary Semifinals Finals Preliminary Semifinals Finals
Dragons Taeguek 4 Koryo Taeguek6& Taeguek 4 Koryo Taeguek6 &
6-7 Taegeuk 5 Taegeuk 5
Tigers Taeguek 4 Koryo Taeguek 6 Taeguek 4 Koryo Taeguek 6
8-9 Taeguek 5 Taegeuk 5
Youth Taeguek 8 Taeguek 5 Taeguek 7 Taeguek 8 Taeguek 5 Taeguek 7
10-11 Koryo Koryo
Cadet Taeguek 5 Taeguek 8 Taeguek 6 Taeguek 5 Taeguek 8 Taeguek 6
12-14 Keumgang Keumgang
Junior Taeguek 5 Taeguek 8 Koryo & Taeguek 5 Taeguek 8 Koryo &
15-17 Taegeuk 7 Taebaek 7
1st Team Taeguek 7 Koryo Taebaek & Taeguek 7 Koryo Taebaek &
18-29 Pyongwon Pyongwon
2nd Team Koryo Taebaek Pyongwon & Koryo Taebaek Pyongwon &
30+ Sipjin Sipjin
1- Forms are the same for some age groups as these groups are combined
2- All Color Belt Division will choose their own two (2) poomsae to perform
Yellow Belt= Taeguek 1 or 2 Green belt= 3 or 4 Blue Belt= 5 or 6 Red Belt= 7 or 811. WEIGH-IN: Weigh-in of the contestants shall be completed one day before their scheduled competition day. During the weigh-in, male Contestants shall wear underpants and female contestants shall wear underpants and brassieres. All competitors must weigh- in on Friday November 16, 2018 by 8:00 PM. 12. CONDITIONS OF PARTICIPATION: Round trip airfare, room and board accommodation, transportation and entry fees charges shall be borne by the participant.
13. AWARDS Las Vegas Open International Championship and members of this event will present medals to all participants finishing 1st through 3rd place in Sparring and Forms (there will be two 3rd place medalists in sparring and forms). All athletes participating at this event will get points for USAT ranking system Black Belt and Color Belts We are proud to present our Grand Championship Prize Only Black belts Sparring and Forms PLEASE ASK FOR DETAILS IN THIS. Sparring Black Belt Division Only – Male & Female Cadet Junior and Senior First Place $300 Forms black Belt division Only- Male & Female Cadet Junior Senior First place $ 300 REFEREE TEAM SUPPORT IR REFEREE $ 200.00 USAT REFEREE $100.00
15. Event Schedule
(Subject to Change) All times are local
FRIDAY NOVEMBER 16, 2018
Event Time Location
Weight - in 12:00am:0 -8:00 PM South Paradise Room
Referee Meeting 8:00 PM Front Stage
SATURDAY NOVEMBER 17, 2018
Coach & Referee Meeting 7:45am Front Stage
Poomse / Forms 8:00 am South Paradise
All Black Belts and Color belts Room
report to staging area
Kyoroogi Sparring 10:00 am South paradise
5-11 years Old Black and Color belts Room
report to the staging area
Cadet and Juniors Black belt and 11:00 am South Paradise
color Belts report to the staging area Room
All Senior Black belt and color belts
report to the staging area 1:00 pm South Paradise
RoomCODE OF CONDUCT/DISCIPLINARY ACTIONS
Any person registered for the event that is causing unfavorable situations either prior to, during, or after the 2014 LAS VEGAS OPEN
INTERNATIONAL TAEKWONDO CHAMPIONSHIP is subject to disciplinary action as decided by the Competition Supervisory Board. In
particular, the use of alcohol or drugs by athletes, coaches, officials, or staff during the course of the event will disqualify the guilty
individual from further competition. There are no warnings for alcohol or drug consumption by underage participants.
The following outline is the Code of Conduct for Las Vegas Open International Taekwondo Championship. The Code is for all athletes, coaches,
event specialists, and international referees and staff members to fully abide by when participating in any and all USAT sanctioned event.
Failure to comply with the following guidelines can result in the removal from an event, dismissal from future USAT sanctioned events,
and/or the complete suspension from participation as a competitor, coach or staff member in future USAT sanctioned events.
One will act in a manner consistent with the spirit of fair play and responsible conduct.
One will acknowledge, respect and adhere to the authority of Las Vegas Open appointed event staff and tournament staff if necessary.
One will fully comply with USAT and the World Taekwondo Federation (WTF) uniform requirement.
One will maintain an appropriate level of fitness to promote optimal athletic performance.
One will refrain from the excessive use of performance-limiting drugs, including, but not limited to, tobacco and alcohol.
One will refrain from using any substance on the Olympic Movement Anti-Doping Code, as enforced by USADA.
One will abide by the policies and rules established by USAT, the USOC and the WTF.
One will abide by the rules of this particular competition as stated in this packet.
One will respect others, including coaches, competitors, officials, and spectators.
One will not engage in, nor tolerate, any form of verbal, physical or sexual abuse.
One will respect the property of others.
One will refrain from illegal or inappropriate behavior that would deter from a positive image of oneself and Las Vegas Open.
One will maintain a positive attitude and act in a way that will bring honor to oneself, the staff, and the sport of Taekwondo, USAT and the United
States of America.
One will remember that I am an ambassador of USAT, my country and the Olympic movement.
Las Vegas Open recognizes that this Code does not establish a comprehensive set of rules that prescribes every aspect of appropriate behavior.
_____________________________ ______________________________ _________________
Participant's Printed Name Participant's Signature Date
______________________________ ______________________________ _________________
Parent/Guardian's Printed Name Parent/Guardian's Signature DateVEGAS OPEN INDIVIDUAL CONSENT FOR MEDICAL TREATMENT
I, ___________________________________, consent to medical treatment for athletic related
injuries/illnesses by Vegas Open Medical Personnel and /or Hospital Medical Staff at any USA
Taekwondo Sanctioned Event. I authorize treatment by such personnel in the event of injury or illness.
This care includes but is not limited to: preventative taping and padding; first aid treatment of injuries
and illnesses; medication for illness or injury treatment, including over-the-counter medications such as
ibuprofen or acetaminophen; emergency care of injuries, which may include use of a backboard and
cervical collar; suturing, splinting or casting of wounds/injuries on site or in medical treatment facility;
chiropractic adjustments and care; acupuncture treatments; use of AED, injected medications, oxygen
or IV to stabilize an athlete’s condition on site or in route to a medical treatment facility; and any other
medical and/or life-sustaining treatment deemed necessary for athlete to continue competition or
deemed by medical personnel to be in the best interest of the health and well-being of the athlete.
___________________________________________________________ ______________
(Athlete's Signature) (Date)
As a parent or legal guardian of _____________________________, who is under the age of 18, I hereby
authorize medical treatment in the event of an injury or illness as outlined above for
_______________________ while he/she is participating in a Vegas Open event by a member of Vegas
Open Medical Personnel and/or Hospital Medical Staff.
____ I DO NOT AGREE ____ I AGREE, with the following exceptions to treatment:
_________________________________________ ____________________
(Parent/Guardian Signature) (Date)All medical evaluations completed by Las Vegas Open Medical Personnel for athletic injuries are
considered confidential and will be filed under the direction of the Las Vegas Open Medical
Coordinator. Copies of medical injury forms can by requested verbally from the Las Vegas
Open Medical Coordinator by the injured athlete, or parent of a minor athlete at the time of
injury or requested in writing following a competition. The original injury report form will
remain on file. No information about an individual athlete will be released without that
athlete's permission per Federal Guidelines except where it is necessary to file insurance
claims directly associated with the injury or illness. Information pertaining to injury data
without using an athlete's name will be released to the Medical Director, the Medical
Coordinator or their assistants for purposes of injury research or recommendations for
safety rule changes only. An athlete's name and injury will only be released in cases
pertaining to head injures requiring the athlete to not compete for 30 days per Las Vegas
Open rules. This information will be released to the Medical Director, Medical Coordinator,
Referee Chairperson, Tournament Committee Chairman, National Events Director, Executive
Director and documented within the secured Las Vegas Open online registration program for
purposes of enforcing the 30-day-out rule in compliance with Las Vegas Open rules.
I have read and understand the above information as it pertains to my medical records of injury
or illness which may occur and be treated at USA Taekwondo Sanctioned events. I also
understand that if these guidelines are not followed as stated above that Las Vegas Open
could be found in violation of Federal Guidelines set forth by HIPAA.
___________________________________ __________________________________
(Athlete's Signature) (Parent/Guardian Signature)
_______________ _____________
(Date) (Date)_________________________________, consent to having my image photographed while injured or ill by
Las Vegas Open Staff Photographer or Las Vegas Open Medical staff for purposes of documentation of
the injury and/or publicity for Las Vegas Open, USA Taekwondo Sports Medicine. This publicity may
include but is not limited to advertisement in print or on the websites of said organizations. I know I
have the right to decline the photographing of my image at the time of injury if verbally requested by
myself, my parent or my coach per Federal Guidelines set forth by HIPAA. Furthermore I know I can
request that such images be removed from publication or public view if I decide to decline their use at a
later date for any reason simply by making that request in writing directly to the Las Vegas Open
National Office. I understand that such pictures may be taken without any expectations of compensation
for said photographic images.
____ I Agree ____I Decline
_____________________________________________ _____________________
(Athlete’s signature) (Date)
As a parent or legal guardian of _________________________________________, who is under the
age of 18, I hereby authorize photographic images of _________________________________________
to be allowed if injured or ill unless otherwise verbally requested at time of injury/illness that no such
photographs be taken at that time. Furthermore I know I can request that such images be removed from
publication or public view if I decide to decline their use at a later date simply by making that request in
writing directly to the Las Vegas Open National Office.
____ I Agree ____ I Decline
_____________________________________________ ________________________
(Parent/Guardian signature) (Date)INSURANCE INFORMATION:
Primary Insurance Company: ________________________________ Policyholder’s Name: ___________________________
Insurance Address: _____________________________________________________________________________________
Insurance Phone: __________________ Policy #: __________________ Claimant's Name (Print): ______________________
WAIVER AND RELEASE OF LIABILITY, ASSUMPTION OF RISK AND PARENTAL CONSENT AND INDEMNITY AGREEMENT
• In consideration of your acceptance of my entry or that of the minor child, I do hereby, for myself or the minor child, my heirs,
executors and administrators waive, release, discharge, covenant not to sue, and agree to indemnify and save and hold
harmless any and all rights and claims for damages which I may have or may accrue to me against Las Vegas Open and for its
states and district associations, this athletic meet, its organizing committee, the United States Olympic Committee, all members
of this athletic meet, or their respective officers, committees, medical committee, agents, representatives, successors, sponsors,
advertisers, volunteers, owners and lesser of premises on which the athletic meet takes place, assignees and against any
competitor for any and all damages which may be sustained by me or the minor child, in connection with my association with or
entry in the above athletic meet, or which may arise out of traveling to, participating in, and returning from this athletic meet. I
understand that all entry fees are nonrefundable.
• I understand the nature of Las Vegas Open activities and believe that my experience and capabilities, or that of the minor child, to
be qualified to participate in this athletic meet. I understand that Las Vegas Open activities involve risks and dangers of serious
bodily injury, including permanent disability, paralysis and death. These risks and dangers may be caused by myself or the minor
child's own actions, or inactions, and/or the actions or inactions of others participating in the athletic meet.
• If the minor child or I are selected, I agree to be drug tested pursuant to the United States Olympic Committee National Anti-
Doping Program, as amended. I understand that such drug testing may take place at any time during the competition. If the
minor child or I fail to show up at the athletic meet, for any reason, I knowingly forfeit this competition and all applicable
registration fees. I further understand that any pictures taken of the minor child or me in connection with this athletic meet may
be used by Las Vegas Open for publicity or promotion without compensation.
• I have read this agreement, fully understand it's terms, understand that I or the minor child have given up substantial rights by
signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and
unconditional release of all liability to the greatest extent allowed by the law 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's Printed Name Participant's Signature Date
_______________________________________ _______________________________________ _________________
Parent/Guardian's Printed Name Parent/Guardian's Signature DateLas Vegas Open International Taekwondo Championship strives to provide an
enjoyable event experience for all our dedicated athletes, coaches, parents and
fans.
If you have any questions concerning the 2018 Las Vegas Open International
Taekwondo Championships Taekwondo please feel free to contact us.
Thank you again for you continued support and best of luck to all. “VIVA LAS VEGAS”
George Tapia
702-682-7523
grandmastertapia@gmail.com
www.lasvegasopentkd.com
Eric Winiger
Event Manager USA TKD
1 Olmpic Plaza
Colorado Springs, CO 80909
Phone: 719-866-4632
Fax: 719-866-4642You can also read
