J K Lee Academy - Tournament of Champions
             

All Black Belt Breaking Competitors MUST fill out the Breaking Worksheet in the same format as the Sample Worksheets. Only online submissions will be considered.
The downloadable PDF worksheet is found on the main tournament page along with the tentative schedule of events.

Black Belt Breaking registration closes on March 23rd
Early Event Registration ends March 23rd

For more information please visit http://jkleeblackbelt.com/tournament/

If you need more information or have a question, please contact us.

jkleetournament@gmail.com
Phone: 262-547-5425
Date: March 30, 2019
Location: Homestead High School
5000 W. Mequon Road, Mequon, WI 53092

***Spe
ctator Tickets may be purchased at your Martial arts school or at the entrance to the Tournament***
Child Spectator - $4 early or $6 at the door
Adult Spectator - $6 early or $8 at the door
 


Registration
Please select the number of participants below, press enter, and complete all the questions for each participant.
1 or 2 Event Registration:   $75.00   Quantity:   Item Subtotal:  
$0.00
Participants Full Name (First Last) [1]
Participant Age [1]
Participant Gender [1]
Rank [1]
TKD Instructor's Name [1]
Please select your event(s). [1]
Which Location does the Participant Attend? [1]
If Other Location is selected above, please list school [1]

Participants Full Name (First Last)

[2]
Participant Age [2]
Participant Gender [2]
Rank [2]
TKD Instructor's Name [2]
Please select your event(s). [2]
Which Location does the Participant Attend? [2]
If Other Location is selected above, please list school [2]

Participants Full Name (First Last)

[3]
Participant Age [3]
Participant Gender [3]
Rank [3]
TKD Instructor's Name [3]
Please select your event(s). [3]
Which Location does the Participant Attend? [3]
If Other Location is selected above, please list school [3]

Participants Full Name (First Last)

[4]
Participant Age [4]
Participant Gender [4]
Rank [4]
TKD Instructor's Name [4]
Please select your event(s). [4]
Which Location does the Participant Attend? [4]
If Other Location is selected above, please list school [4]

Participants Full Name (First Last)

[5]
Participant Age [5]
Participant Gender [5]
Rank [5]
TKD Instructor's Name [5]
Please select your event(s). [5]
Which Location does the Participant Attend? [5]
If Other Location is selected above, please list school [5]

Participants Full Name (First Last)

[6]
Participant Age [6]
Participant Gender [6]
Rank [6]
TKD Instructor's Name [6]
Please select your event(s). [6]
Which Location does the Participant Attend? [6]
If Other Location is selected above, please list school [6]

Participants Full Name (First Last)

[7]
Participant Age [7]
Participant Gender [7]
Rank [7]
TKD Instructor's Name [7]
Please select your event(s). [7]
Which Location does the Participant Attend? [7]
If Other Location is selected above, please list school [7]

Participants Full Name (First Last)

[8]
Participant Age [8]
Participant Gender [8]
Rank [8]
TKD Instructor's Name [8]
Please select your event(s). [8]
Which Location does the Participant Attend? [8]
If Other Location is selected above, please list school [8]

Participants Full Name (First Last)

[9]
Participant Age [9]
Participant Gender [9]
Rank [9]
TKD Instructor's Name [9]
Please select your event(s). [9]
Which Location does the Participant Attend? [9]
If Other Location is selected above, please list school [9]

Participants Full Name (First Last)

[10]
Participant Age [10]
Participant Gender [10]
Rank [10]
TKD Instructor's Name [10]
Please select your event(s). [10]
Which Location does the Participant Attend? [10]
If Other Location is selected above, please list school [10]
 
3 or 4 Event Registration:   $80.00   Quantity:   Item Subtotal:  
$0.00
Participants Full Name (First Last) [1]
Participants Age [1]
Participant Gender [1]
Rank [1]
TKD Instructor's Name [1]
Please select your events.
[1] Individual Forms
Breaking
Sparring
Family Forms

Which Location does the Participant Attend? [1]
If Other Location is selected above, please list school [1]

Participants Full Name (First Last)

[2]
Participants Age [2]
Participant Gender [2]
Rank [2]
TKD Instructor's Name [2]
Please select your events.
[2] Individual Forms
Breaking
Sparring
Family Forms

Which Location does the Participant Attend? [2]
If Other Location is selected above, please list school [2]

Participants Full Name (First Last)

[3]
Participants Age [3]
Participant Gender [3]
Rank [3]
TKD Instructor's Name [3]
Please select your events.
[3] Individual Forms
Breaking
Sparring
Family Forms

Which Location does the Participant Attend? [3]
If Other Location is selected above, please list school [3]

Participants Full Name (First Last)

[4]
Participants Age [4]
Participant Gender [4]
Rank [4]
TKD Instructor's Name [4]
Please select your events.
[4] Individual Forms
Breaking
Sparring
Family Forms

Which Location does the Participant Attend? [4]
If Other Location is selected above, please list school [4]

Participants Full Name (First Last)

[5]
Participants Age [5]
Participant Gender [5]
Rank [5]
TKD Instructor's Name [5]
Please select your events.
[5] Individual Forms
Breaking
Sparring
Family Forms

Which Location does the Participant Attend? [5]
If Other Location is selected above, please list school [5]

Participants Full Name (First Last)

[6]
Participants Age [6]
Participant Gender [6]
Rank [6]
TKD Instructor's Name [6]
Please select your events.
[6] Individual Forms
Breaking
Sparring
Family Forms

Which Location does the Participant Attend? [6]
If Other Location is selected above, please list school [6]

Participants Full Name (First Last)

[7]
Participants Age [7]
Participant Gender [7]
Rank [7]
TKD Instructor's Name [7]
Please select your events.
[7] Individual Forms
Breaking
Sparring
Family Forms

Which Location does the Participant Attend? [7]
If Other Location is selected above, please list school [7]

Participants Full Name (First Last)

[8]
Participants Age [8]
Participant Gender [8]
Rank [8]
TKD Instructor's Name [8]
Please select your events.
[8] Individual Forms
Breaking
Sparring
Family Forms

Which Location does the Participant Attend? [8]
If Other Location is selected above, please list school [8]

Participants Full Name (First Last)

[9]
Participants Age [9]
Participant Gender [9]
Rank [9]
TKD Instructor's Name [9]
Please select your events.
[9] Individual Forms
Breaking
Sparring
Family Forms

Which Location does the Participant Attend? [9]
If Other Location is selected above, please list school [9]

Participants Full Name (First Last)

[10]
Participants Age [10]
Participant Gender [10]
Rank [10]
TKD Instructor's Name [10]
Please select your events.
[10] Individual Forms
Breaking
Sparring
Family Forms

Which Location does the Participant Attend? [10]
If Other Location is selected above, please list school [10]
 

Boards
Only boards purchased from the tournament will be allowed

(White - High Green Belts) each competitor needs 2 boards.
(Brown - High Red Belts) each competitor needs 3 boards.
(Black Belts) each competitor needs 5 boards.

Please enter the number of boards needed, and press enter.
3-8 years old - 4 in. wide 1/2 in. thick:   $2.00   Quantity:   Item Subtotal:  
$0.00
9-12 years old - 5 in. wide x 1 in. thick:   $3.00   Quantity:   Item Subtotal:  
$0.00
13-15 years old & Adult Womens - 8 in. x 1 in.:   $3.00   Quantity:   Item Subtotal:  
$0.00
Adult Mens (16 years old plus) - 10 in. x 1 in.:   $3.00   Quantity:   Item Subtotal:  
$0.00
 

Donation
I would like to donate $5.00 towards the J.K. Lee City Youth Martial Arts Program (CYMAP) participants. 
CYMAP is an independent certified 501(c)(3) nonprofit organization which brings the many
benefits of martial arts to youth in under-served neighborhoods.
 All donations are tax deductible.   
Thank you for you support!!!
CYMAP Donation:   $5.00   Quantity:   Item Subtotal:  
$0.00
 
Total:
$0.00
Parent/Guardian/Payer Information
First Name: Last Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone: Email:
Payment Information
Method of Payment:
Update name from Parent/Guardian/Payer Information
Name of Individual
on Checking Account:
Name of Individual
on Savings Account:
Name of Business
on Checking Account:
Bank Routing Number:
Bank Account Number:
Credit Card Number: (Type number or swipe with cursor in this empty field)
Expiration Date: /
Cardholder Information (exactly as it appears on your statement)
  Update from Parent/Guardian/Payer Information
Cardholder's Name:
Billing ZIP/Postal Code:

I am aware that I am being allowed to watch, participate and receive instruction in Tae Kwon Do and other martial arts related activities at  Brookfield Waukesha Ventures Corporation dba J.K. Lee Black Belt Academy also referred as "The School" and in all competitions and tournaments in Wisconsin. Tae Kwon Do and other related martial arts are activities that can be physically demanding and involve the risk of personal injury, including assisting in any manner such as holding targets, bricks, and boards and assisting with weapons, I agree, personally or on behalf of my child, to release and waive any claims or causes of action, including claims for injuries caused by the negligence of the School and/or its owners, employees, agents and volunteers of the School arising out of any injuries that I (or my child) may sustain as a result of my (or my child's) participation or attendance at the School and their sponsored events, I further agree to indemnify and hold the School harmless against any and all claims resulting from such injuries to myself (or my child). Including claims or injuries caused by the negligence of the School. Furthermore, I give my consent to the instructors or other medical personnel to treat me (or my child) in a medical situation. By signing below, the undersigned indicated that he/she understands the above agreement. All payments made to the School are non-refundable.

PHOTOGRAPHS - VIDEO:

The student hereby grants to the School permission to photograph, video, or otherwise record in any media now known or later created the students performance (whether during lessons, in practice sessions, classes. fair, outside events or otherwise) (together, "Photographs"). The School owns all copyrights in and to the Photographs, and the student hereby transfers and assigns to the School any copyrights that the student may have in such Photographs.

MODEL RELEASE:

The student hereby grants to the School and its legal representatives and assigns, the irrevocable and unrestricted right to use and publish photographs or video of the student or in which the student may be included, for editorial, website, trade, advertising and any other purpose and in any manner and medium; to alter the same without restriction; and to copyright the same, The student hereby releases the School and its legal representatives and assigns from all claims and liability relating to said photographs. There will be no refunds.

I have read the statement above:
All Participants/Parents/Guardians have read and agree with the statements above
 

If you are purchasing Boards, please select the "Email Event Receipt" on the next page.  Once the email is received, please print it and bring it to the Tournament to claim your Boards.


 
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