WAKO INDIA NATIONAL KICKBOXING CHAMPIONSHIP-2024
(Seniors & Masters-Men & Women - All Events)
Date: 24 to 28 July 2024
WAKO At: Multipurpose Indoor Stadium, Dayanand Bandodkar Krida Sankool.
INDIA Peddem, Mapusa, Goa
NO:
Organized By: Amateur Sports Kickboxing Association of Goa
AMliated with: WAKO India Kickboxing Federation®
Recognized by: Ministry of Youth Affairs &Sports, Govt. of India
Member: World Association of Kickboxing Organizations (WAKO)
Waiver of Linbilities
(Fill in CAPITAL LETTERS)
R Sports ID No.
1) State/UT Asso: PuATAA kckAoxINâ issocIATIN
2) Participant Name: koa DEVT
3) DOB: 9-ol-000 Age: 4 Gender P
4) Weight: -50 Kg: Events:
Devi the undersigned knowingly and without
compulsion / duress, do voluntarily submit my entry to compete/participate in WAKO INDIA Seniors &
Masters National Kickboxing Championship - 2024 (Men & Women) from 24 to 28 July 2024 at
Multipurpose Indoor Stadium, Dayanand Bandodkar Krida Sankool, Peddem, Mapusa, Goa, India, subject
to the acceptance of my participation by the organization committee/ Federation. I hereby assume all risks
of physical and mental injuries disabilities and losses which may result from or in connection with my
participation and I shall neither hold the organizer, nor my Home Association/ Unit responsible for the
same. I agree to abide by the Rules and Regulations of the Organizing Committee / WAKO India
Kickboxing Federation. Ifurther agree that in the event of any dispute, it must be addressed in accordance
with the concerned Rules and Regulations. I have read and fully understood the waiver listed above, and the
bio-data and my medical fitness documents given by me are true to the best of my knowledge.
Recommended by Signature of the Participant
President/Secretary State/UT Assn.
(FOR OEEICE USE ONLY
EVENTMEDICALTEAM OBSERVATIONASSESSMENT
I, the undersigned, hereby certify that
has undergone medical examination under my observation and he/she is physically and mentally fit to
participate in the above-mentioned Kickboxing sport event.
Remarks If Any:
Fitness Recommended by
Licensed Doctor with sign &seal
Date:
Address: WAKO Indisa Office No. 7, 1" Floor, Achievers Cntre Point Mall. Sector-9, Faridabud, Haryana, INDLA
Phone No. 0129-4155205; E. mail: [email protected]
