2014 Australian Kung-Fu Wushu Championships

4th May 2014

Monash University – Clayton Campus Sport and Recreation Centre

Basketball Stadium Wellington Road, Clayton, VIC

Conducted by Kung Fu Wushu Victoria

KWV officially recognised by Kung Fu Wushu Australia and Department of Sports and Recreation as the peak governing body for Kung Fu (Wushu) in Victoria.

KWA officially recognised by the Australian Sports Commission as the peak governing

body for Kung Fu (Wushu) in Australia.

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TABLE OF CONTENTS

GENERAL INFORMATION ...................................................................................................... 1  ROUTINE COMPETITION RULES AND REGULATION ......................................................... 3  SPARRING COMPETITION RULES AND REGULATION ....................................................... 6  CERTIFICATE OF FITNESS (SANDA FULL CONTACT) ..................................................... 11  SEROLOGY REPORT (SANDA FULL CONTACT) ............................................................... 16  APPLICATION INDEMNIFICATION WAIVER FORM TO PARTICIPATE ............................. 17  

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2014 Australian Kung-Fu Wushu Championships

GENERAL INFORMATION

1. Championship Date Sunday 4th May 2014 9:00 am – 4:00pm (Registration 8:30am) The Championship Organising Committee reserves the right to make changes to the programme which are deemed fit.

2. Championship Venue

Monash University – Clayton Campus Sport and Recreation Centre Basketball Stadium Wellington Road, Clayton, VIC

3. Competitors Qualification For Entry

(a) Members of Kung Fu Wushu Australia’s State Associations are eligible to participate in the Championships.

(b) Competitors must submit the required documentation and pay the designated fees (refer to Championship Fees and Registration)

4. Registration

(a) Internet Sign Up System will be adopted. The competitors shall fill out online Entry Forms and make payment via the Internet.

(b) Website for Internet Registration System: http://www.2014nationals.eventbrite.com.au

(c) Closing date for internet registration is Friday, March 28 2014. Online entries must be received by this date. Late entries will not be accepted.

(d) Competitors must also submit the completed and signed Waiver Form by the registration closing date and can either email to waiver@kwvic.com.au or post to:

Mr Ian Hadfield 2013 Victorian Kung Fu Wushu Championships PO Box 2238 Bayswater VIC 3153

(e) Any competitor who has registered online and also supplied the required documentations by the required dates will be entered into the Championships.

(f) No changes or additional entries will be accepted after the deadline. (g) Refunds only issued in special cases and will be subject to administration costs as decided by

the Championship Organising Committee. (h) All competitors are required to check-in on the day of their event. Any competitor who does not

check-in by within 30 minutes of their event may be forfeited to compete and entry monies will be retained by KWA:

5. Travel and accommodation

All travelling expenses (eg. air fare and transportation), accommodation, tours and sightseeing are at own expense.

6. Anti-Doping Policy

All competitors must comply with the KWA Anti-Doping Policy which can be viewed at www.kungfuwushuaustralia.com therefore agreeing to any random drug testing as requested by the Australian Sports Drug Agency.

7. Enquiries

For further information and enquires regarding the Championship, please contact:

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President Kung Fu Wushu Victoria: Dana Wong Email: president@kwvic.com.au

General Enquiries: Ian Hadfield Email: tournament@kwvic.com.au

Sparring Event Coordinator: Bruce Corles Email: sparring@kwvic.com.au

Unacceptable Behaviour Disciplinary Procedures The KWA has a zero tolerance policy towards unsportsmanlike, disruptive and unprofessional behaviour. Competitors will be immediately disqualified from this event for conduct which the Chief Referee of that event considers to be unsportsmanlike, disruptive or unprofessional. This conduct may include, but not be limited to, cheating, dishonesty, failing to comply with the reasonable directions of a competition official, jeering, interference with the activities of competition officials, publicly criticising judges' decisions outside the appeals process laid down in this documents and any other form of behaviour likely to bring the sport into disrepute. In the event of a complaint about the conduct of a competitor, the Chief Referee must be notified ASAP of the incident. It is the Chief Referee's responsibility to advise the competitor, on the spot, that he/she will be disqualified. Other persons may be expelled from the event for conduct which the Chief Referee finds unacceptable.

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ROUTINE COMPETITION RULES AND REGULATION 1. Championship Events and Age Divisions

• Age Divisions - Child 7 to 12 years old - Junior 13 to 15 years old - Youth 16 to 18 years old - Adult 19 to 45years old - Senior 46 years and above

Note: Age is based on the competitor’s birthday during the championship year.

• Kung Fu Events

Bare Hand: - Northern Style (Northern Shaolin, Northern Praying Mantis, etc) - Southern Style (Jow Gar, Hung Gar, Choy Li Fut, White Crane, Wing Chun, Bak Mei,

Ging Mo Kune, etc) - Other Style (Xing Yi Quan, Ba Gua Zhang, Ba Ji Quan, etc) Weapon: - Long Weapon - Short Weapon - Other Weapon (Flexible, Double Weapons, etc)

• Wushu Taolu Events

- Changquan, Daoshu, Jianshu, Gunshu, Qiangshu - Nanquan, Nandao, Nangun - Taijiquan, Taijijian

• Tai Chi Events

Bare Hand: - 24 Step Simplified Tai Chi - 42 Step Competition Tai Chi - Yang Style - Chen Style - Wu Style - Sun Style - Wu (Hao) Style - Other Style Weapon: - 32 Step Elementary Straight Sword - 42 Step Competition Straight Sword - Other Straight Sword - Other Weapon (Fan, Broadsword, etc)

• Duel Events

- Choreographed sparring sets of Bare Hand to Bare Hand, Weapon to Weapon or Bare Hand to Weapon

Note: Championship Organising Committee has the power to merge any division or events

if insufficient number of competitors for any division or events occurs.

A photocopy of your current Prohibited Weapon License must accompany your Championship Entry Form if your events involve any weapons prohibited in Victoria. You must also bring your license on the day of the Championship. For more information on what weapons are prohibited in VIC, please go to: http://www.police.vic.gov.au/content.asp?Document_ID=25574

2. Participation Methods

• Each routine competitor may enter at most: - one bare-hand event - one weapon event

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- one duel event - one group event for a maximum of 4 (four) events

• Duel event is limited to 2-3 persons. Male and female mixed teams are not allowed. • In group events, teams shall consist of no less than 6 persons and no more than 10. Male

and female competitors can be mixed. Each participating organisation may only enter one group team.

3. Relevant Rules

• The competition shall be individual competition.

• The competition rules will be based on the “Rules for International Taolu Competition” endorsed by IWUF in 1999.

• Music should be accompanied to the group routine. CD shall be brought by the participating

teams. No lyrics are allowed, otherwise 0.10 points will be deducted by the head judge. The head judge will deduct 0.10 points if the group performs without music.

• The power of interpretation of the Rules rests solely with the Chief Judge.

4. Time Requirements for Routine Events

(a) Kung Fu Events: • Bare hand and Weapon routines: Not less than 45 seconds and not more than 1 minute

and 30 seconds.

(b) Wushu Events • Changquan, Nanquan and Weapon routines:

- Adult and Youth Age Group: Not less than 1 minute and 20 seconds and not more than 1 minute 40 seconds.

- Child and Junior Age Group: No time limit.

• Taijiquan and Taijijian routines: - Not less than 3 minutes and not more than 4 minutes. And NO warning bell will be

given.

(c) Tai Chi Events • 24 Step Simplified Tai Chi: not less than 4 minutes and not more than 5 minutes. Warning

bell given at 4th minute. • 42 Step Competition Tai Chi: not less than 5 minutes and not more than 6 minutes.

Warning bell given at 5th minute. • All other bare hand style routines: not less than 3 minutes and not more than 6 minutes.

Warning bell given at 5th minute. • All sword routines: Not less than 3 minutes and not more than 4 minutes. Warning bell

given at 3rd minute. • All other weapon routines: Not less than 2 minutes and not more than 4 minutes. Warning

bell given at 3rd minute.

(d) Duel Events: Not less than 45 seconds and not longer than 1 minute and 30 seconds.

(e) Group Events • Not less than 2 minutes and not longer than 4 minutes.

5. Competitors Costume, Uniform, Foot Wear & Equipment

(a) Wushu Taolu events • Competitors must wear wushu taolu competition costume in compliance with the “Rules for

International Taolu Competition” as endorsed by IWUF in 2005 to participate in the competition.

• Martial arts style athletic or any rubber-soled sports shoes/sneakers must be worn

(performance with bare feet is not allowed).

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• Competitors shall bring their own competition weapon for their own respective events.

• Jewellery, including watches may not be worn. Nails must be clipped short and metal hair

clips are also not to be worn. No heavy metal, body piercing, earrings or rings. If a ring cannot be removed, it must be taped.

Note: Failure to comply with these rules will result in disqualification from their event. (b) All other routine events

• Kung Fu Costume: traditional kung-fu costume, or official Academy / Club / School martial arts uniform.

• Tai Chi Costume: traditional tai chi costume or official Academy / Club / School martial

arts uniform.

• If the competitor has no costume or uniform, a plain T-shirt, track pants and a sash must be worn.

• Martial arts style athletic or any rubber-soled sports shoes/sneakers must be worn

(performance with bare feet is not allowed).

• Competitors shall bring their own competition weapon for their own respective events.

• Jewellery, including watches may not be worn. Nails must be clipped short and metal hair clips are also not to be worn. No heavy metal, body piercing, earrings or rings. If a ring cannot be removed, it must be taped.

Note: Failure to comply with these rules will result in disqualification from their event.

6. Placing and Awards The top three places for each event will be awarded as follows:

1st Place Gold Medal 2nd Place Silver Medal 3rd Place Bronze Medal

7. Championship Fees

Australian Dollars KWA Members First individual routine event $40 per person Second individual routine event $15 per person Duel routine event $15 per person Group routine event $10 per person

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SPARRING COMPETITION RULES AND REGULATION

1. Championship Events and Age Divisions

(a) Controlled Contact Sparring Events • Age Divisions

- 6 – 7 years old - 8 – 9 years old - 10 – 11 years old - 12 – 14 years old - 15 – 17 years old - 18 – 35 years old - 36 to 55 years old

Note: Age is based on the competitor’s birthday during the championship year.

• Weight Classes: - Men and Women: below (kg): 36, 40, 44, 48, 52, 56, 60, 65, 70, 75, 80, 85, 90,

over 90kg

Championship Organising Committee has the power to merge any divisions if insufficient number of competitors for any divisions occurs.

(b) Sanda Full Contact Sparring Events

• Age Divisions - Youth 16 to 18 years old - Adult 19 to 35 years old

Note: Age is based on the competitor’s birthday during the championship year.

• Weight Classes:

- Men (15 – 17 years): below (kg): 48, 52, 56, 60, 65, 70, 75, 80 - Women (15 – 17 years): below (kg): 48, 52, 56, 60 - Men (18 – 55 years): below (kg): 48, 52, 56, 60, 65, 70, 75, 80, 85, 90, over 90kg - Women (18 – 55 years): below (kg): 48, 52, 56, 60, 65, 70, 75

Note: Championship Organising Committee has the power to merge any 2 neighbouring division or events if insufficient number of competitors for any division or events occurs.

2. Participation Methods

• Each competitor may register and compete in both controlled contact sparring and sanda

full contact sparring events.

• Each competitor may only enter in 1 (one) weight category. 3. Relevant Rules

(a) Controlled Contact Sparring Events • All techniques must be controlled contact.

• The elimination system will be adopted. If the number of competitors in a weight category is

only 3 (three), a round robin will be adopted. • The competition will be based on the “KWA Controlled Contact Sparring Rules”. These

rules can be obtained at www.kungfuwushaustralia.com

• The competition time for each round shall be two (2) minutes for 15 years and above and above and one (1) minute thirty (30) seconds for 14 years and under. Each bout will be one (1) round.

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• When the bout results in being a draw, a thirty (30) second continuation will take place. If it remains a draw, the head judge will proclaim the winner of the bout.

• A competitor exiting / falling out of the arena twice in a round will lose the round.

• The power of interpretation of the Rules rests solely with the Chief Judge.

• Legal Target Areas

- Torso above the waist including front and side.

- Thighs, inside and outside of thigh area and the leg below the knee.

• Prohibited Areas of Attack - Any part of the head.

- The throat

- The groin.

- The back.

- The knees, elbows and other joints.

• Legal Techniques:

The following techniques are allowed: 6 – 7 yrs

8 – 9 yrs

10 – 11 yrs

12 – 14 yrs

15 – 17 yrs

18 – 35 yrs

35 – 55 yrs

Clinching (max three seconds only)

Sweeps and takedowns

Throws that will not cause injury

Punches to the body

Kicks to the body and legs

Kicks to the inside and outside of thigh area

• Prohibited Methods:

- All techniques which are deliberately intended to injure the opponent rather than to score points are prohibited whether on target or not. The consideration will be judged on what would have happened if the blow had landed.

- Striking to the face whether making contact or as a feint.

- Attacking with the head, the elbow or the knee.

- Direct attach to limbs and joints or twisting the opponent’s joints.

- Dangerous throws – Any throw that is likely to cause serious injury (eg: neck, stomach and shoulder high throws). Throws which cause a competitor to land awkwardly on a vulnerable part of the anatomy (head, neck, spine, shoulder, knee or other joint etc...). Throws with a falling height from above shoulder level.

- Intentionally smashing the opponent head first into the ground.

- Hitting the opponent’s head by any means when he is down.

- Choke or strangle techniques.

- Grappling or wrestling on the mat.

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- Arm locks and similar joint-locking techniques.

- Grasping an opponent with one or two hands and striking with the other hand or

kicking.

- Biting, scratching, hair pulling, spitting etc...

- Strikes to the groin or knees.

- Kicks or punches to the spine.

- Pushing the opponent for more than 1 metre or off the arena.

(b) Sanda Full Contact Sparring Events • The competition shall be Full Contact.

• The elimination system will be adopted. If the number of competitors in a weight category is

only 3 (three), a round robin will be adopted. • The competition will be based on the “Rules for International Wushu Sanshou Competition”

endorsed by IWUF in 2005. These rules can be obtained at www.kungfuwushaustralia.com

• For youth sanda events, kicks to the head as well as successive/continuous punches to the

head are not permitted.

• The competition time for each round shall be 2 minutes for adults and 1 minute 30 seconds for youths. Each bout will be the best of three (3) rounds.

• A competitor exiting / falling out of the arena twice in a round will lose the round.

• The power of interpretation of the Rules rests solely with the Chief Judge.

• Legal Target Areas

- Any part of the head.

- Torso above the waist including front and side.

- Thighs, inside and outside of thigh area and the leg below the knee.

• Prohibited Areas of Attack - The throat

- The groin.

- The back.

- The knees, elbows and other joints.

• Legal Techniques:

- Hand and leg techniques not directed at the back of the head, the neck, the spine, the groin and the knees.

- Takedowns by sweeps and throws that would not result in a neck or spinal injury.

• Prohibited Methods: - Attacking with the head, the elbow or the knee.

- Twisting the opponent’s joints.

- Dangerous throws – Any throw that is likely to cause serious injury (eg: neck, stomach

and shoulder high throws). Throws which cause a competitor to land awkwardly on a

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vulnerable part of the anatomy (head, neck, spine, shoulder, knee or other joint etc...). Throws with a falling height from above shoulder level.

- Intentionally smashing the opponent head first into the ground.

- Hitting the opponent’s head by any means when he is down.

- Biting, scratching, hair pulling, spitting etc...

- Strikes to the groin or knees.

- Kicks or punches to the spine.

4. Competitors Costume, Uniform, Foot Wear & Equipment

(a) Controlled Contact Sparring Events • Competitors to use their own boxing gloves and cotton shin and instep protectors.

Competitors' gloves shall be either red or black.

• The weight of gloves shall be 230 (8 oz) grams for 65kg category and under (and also for women of all categories), and 280 (10 oz) grams for the 70 kg category and above.

• Competitors must use their own mouth guard

• Male competitors must wear their own groin guard. All groin guards must be worn under the

uniform pants. Groin guards are optional for female competitors. ,

• Adult female competitors must wear and bring their own approved chest protector.

• Each competitor must wear his/her traditional martial arts school uniform consisting of shirt or singlet and long pants or shorts, pertaining to his or her school and in good condition. No street clothes are permitted. The Chief Head Judge will have the final say as to whether any clothing is or is not acceptable in competitions.

Note: Failure to comply with these rules will result in disqualification from their event.

(b) Sanda Full Contact Sparring Events

• Competitors shall wear costumes and protective gears in compliance with the “Rules for International Sanshou Competition” as endorsed by IWUF in 2005 to participate in the competition.

• Each competitor must bring their own two (2) sets of costumes: one set of black and one

set of red costumes.

• Gloves and protective gear will be provided by the Organizing Committee except for gum-shield and jockstrap which will be provided by the competitors themselves.

• Hand wraps are not allowed.

Note: Failure to comply with these rules will result in disqualification from their event.

5. Weighing-in

Controlled Contact Sparring Events • The weighing-in will take place on the day of the Championships at the Championship

venue at 8am. Sanda Full Contact Sparring Events

• The weighing-in will take place on the day of the Championships at the Championship venue at 830am.

• Competitors are required to submit a KWA Certificate of Fitness and Serology Report.

These must be issued within 30 days before the Championships and signed by a qualified doctor. This will be submitted during weigh-in.

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6. Placing and Awards

All Sparring Events • The top three places for each event will be awarded as follows: 1st Place Gold Medal 2nd Place Silver Medal 3rd Equal Place Bronze Medal(s)

7. Championship Fees

Australian Dollars KWA Members First sparring event $40 per person Second sparring event $15 per person

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Certificate of Fitness (Sanda Full Contact)

PART ONE – To be completed by the examining medical practitioner

Full Name of the Sanda Contestant _______________________________________________________

Address ____________________________________________________________________________

______________________________________________________________ Postcode ____________

Date of Birth _________________________________ Sex ____________________________________

I certify that this person is in good health to participate in full contact martial arts contests.

Signed _____________________________________ Print Name ______________________________ Medical Practitioner Medical Practitioner

Provider Number _____________________________

Date _______________________________________

Medical practitioner’s stamp

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PART TWO – Medical and Competition History

Division 1 – Personal Details and Competition History (To be completed by the contestant)

Name of Sanda Contestant __________________________________________ Examination Date ________________

Contestant’s address _______________________________________________ Date of birth ____________________

Contestant’s telephone number _______________________________________ Sex ..... M / F (circle one)

1. Career competition history: Career Results Wins Losses Draws

Amateur

Professional

2. Have you suffered any injury while competing? Yes / No (circle one)

3. Have you had any headaches, vomiting or problems with speech or vision after a contest? Yes / No (circle one)

Division 2 – Medical History (To be completed by the medical practitioner)

Yes

No

Yes

No

Yes

No

1. Have you at present any: a. illness b. disability

10. a. Shortness of breath 20. a. Nervous trouble b. Severe depression c. Mental illness d. Attempted suicide

2. Are you now receiving medicine, drugs, or other treatment

11. a. Pneumonia b. Bronchitis or pleurisy

21. a. Kidney disease b. Bladder disease c. Pain passing urine d. Blood in your urine

3. Has an accident or illness kept you off work for more than one week

12. a. Coughing blood b. Coughing up phlegm

22. Frequent indigestion

4. Have you ever had any operations

13. Tuberculosis 23. a. Ulcer of stomach b. Ulcer of duodenum

5. Have you ever been a patient in any hospital: a. Medical b. Other

14. a. Asthma b. Other lung disease

24. a. Gall bladder trouble b. Gall stones

Have you ever had or are you now suffering from any of the following?

15. a. Deafness b. Tinnitus

25. Sugar diabetes

6. a. Rheumatic fever b. Heart disease

16. a. Visual problems b. Do you wear glasses or contact lens

26. a. Hepatitis or other jaundice b. Liver disease

7. Palpitations or pounding heart

17. a. Fainting attacks b. Blackouts

27. a. Rupture b. Hernia c. Swollen or painful testicles

8. High or low blood pressure

18. a. Fits or convulsions b. Epilepsy c. Giddiness

28. a. Any skin trouble b. Tendency to bruise or bleed easily

9. Swollen or painful joints (other than through injury)

19. a. Severe headaches b. Migraines

29. a. Concussion b. Severe head injury c. Loss of consciousness

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Yes

No

Yes

No

Yes

No

30. Knee injury Ankle injury Back injury Other joint injury or dislocation

32. Paralysis (including polio)

34. (Females) Are you pregnant?

31. Fractured bones Chipped bones

33. Any other injury, illness or disability

Medical Practitioner’s Notes on History (A ‘Yes” answer to any question requires the medical practitioner to state the question number and comment here)

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

35. Over the past five (5) years has the contestant, either occasionally or regularly, taken any stimulants, sedatives, medications or drugs by mouth or by injection? Yes / No (circle one)

If ‘Yes”, provide details and, if prescribed by a doctor, include the relevant particulars in question 36 below.

36. Over the past five (5) years has the contestant had any medical examination, advice, treatment or been in hospital?

Yes / No (circle one)

If ‘Yes”, provide particulars of each instance (including x-ray, electrocardiogram or other special tests) in the table below. Date Name and address of doctor and/or

hospital Reason (If illness or injury, give duration and date

of recovery)

37. Details of photographic identification presented to the medical practitioner, eg driver’s licence or passport:

______________________________________________________________________________________________

Contestant’s Declaration and Release of Medical Information Authorisation

I declare that the information in the Certificate of Fitness true and complete to the best of my knowledge and belief.

Contestant’s name (print) _________________________ Signature ______________________ Date _____________

I have completed the above medical history and have witnessed the contestant’s signature.

Signature of medical practitioner __________________________________ Date ___________________________

Print Name ____________________________________________

THIS MEDICAL FORM AND THE INFORMATION HEREIN IS TO REMAIN CONFIDENTIAL AND SECURELY STORED BY THE PROMOTER FOR A PERIOD OF 12 MONTHS FROM THE DATE OF SIGNING.

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PART THREE – Record of Medical Examination Medical Examination

(Medical practitioner to complete) Tick the appropriate column. If not examined, insert ‘NE’ in the Normal column Physical Examination Normal Abnormal Physical Examination Normal Abnormal

1. a. Head, face, scalp b. Neck R.O.M.

15.. Abdomen (include hernial orifices)

2. a. Nose deformity b. Nose airway

16. Endocrine system

3. a. Mouth, throat b. Speech

17. External genitalia

4. a. Teeth, gums b. Dentures Yes / No

18. a. Feet b. Limbs R.O.M. c. Gait

5. a. Ears – general b. Ears - hearing

19. A. Spine b. Trunk R.O.M. c. Posture (standing)

6. Tympanic membranes 20. a. Nervous system b. Cranial nerves

7. Eustachian tubes 21. a. Cerebellum function b. Body balance/ coordination

8. Eyes – general 22. a. Muscle tone b. Muscle strength c. Sensation

9. a. Visual fields b. Eye gaze

23. Reflexes

10. Eye movement 24. Skin

11. Ophthalmoscopic examination

25. Lymphatic system Lymph glands in neck axillae or inguinal

12. Chest, lungs 26. Emotional stability

13. Heart (if ECH performed, note result in section & enclose F MED 53)

27. Other

14. Vascular system (include veins)

28. Identifying marks

29. Frame: Large Medium Small 30. Height: (cm)

31. Chest: (cm) Exp Ins 32. Waist (cm)

33. Urinalysis: Albumin Sugar 34. Weight: (kg)

35. Blood Pressure: Systolic Diastolic 36. Eyes – colour

37. Distant vision: R6 Corr 6 L6 to 6

Near vision: Normal / Abnormal

38 Has a MRI Scan been conducted? Yes / No Is the MRI satisfactory Yes / No

Any further testing required? Yes / No Please attach a copy of the radiologist’s report.

39. Medical Practitioner’s Notes on Medical Examination (provide details of any abnormality noted and enter the relevant question number before each comment)

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

40. Is any further testing required? Yes / No (circle one)

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Neuro/Psychological Examination

Yes No

41. Is there any evidence of a change in character?

42. Has the contestant a good memory for recent events and, in particular, recent contests?

43. Does the contestant follow conversation with attention and intelligence?

44. Is there any evidence of a tendency to violence outside the competitive arena?

45. Medical Practitioner’s Notes on Neuro/Psychological Examination (state whether further assessment is required)

______________________________________________________________________________________________

______________________________________________________________________________________________

46. Particulars of any Disabilities

______________________________________________________________________________________________

______________________________________________________________________________________________

47. Medical Practitioner’s Summary

Name of examined contestant ______________________________________________________________________

Do you consider the contestant to be in good health to participate as a contestant in full contact martial arts contests?

Yes No Further Assessment Required (circle one) Any comments:

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

Signature of medical practitioner _______________________________________________ Date ________________

Name of medical practitioner (please print) ________________________________ Telephone number ____________

Address of practice _______________________________________________________________________________

THIS MEDICAL FORM AND THE INFORMATION HEREIN IS TO REMAIN CONFIDENTIAL AND SECURELY STORED BY THE PROMOTER FOR A PERIOD OF 12 MONTHS FROM THE DATE OF SIGNING.

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Serology Report (Sanda Full Contact)

Medical Practitioners Report

I certify that:

Name of Sanda contestant _________________________________________________________

Address of Sanda contestant _______________________________________________________

______________________________________________________________________________

Attended for tests for H.I.V., Hepatitis B Antigen and Hepatitis C on _____________________________ (insert date)

The test results:

i. H.I.V. Negative q Other ________________________________________

ii. Hepatitis B Antigen Negative or immune q Other ___________________________

iii. Hepatitis C Negative q Other ________________________________________

Comment on results not negative or immune

___________________________________________________________________________________

___________________________________________________________________________________

Medical Practitioners Signature ________________________________________________________ Date ________________________

Please Print:

Name of medical practitioner _____________________________ Telephone No. __________________

Practice Address _____________________________________________________________________

___________________________________________________________________________________ THIS MEDICAL FORM AND THE INFORMATION HEREIN IS TO REMAIN CONFIDENTIAL AND SECURELY STORED BY THE PROMOTER FOR A PERIOD OF 12 MONTHS FROM THE DATE OF SIGNING.

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APPLICATION INDEMNIFICATION WAIVER FORM TO PARTICIPATE

IN THE 2014 AUSTRALIAN KUNG-FU WUSHU CHAMPIONSHIPS

4th May 2014

Monash University – Clayton Campus

PARTICIPATING IN A MARTIAL ARTS TOURNAMENT IS DANGEROUS AND CAN CAUSE SERIOUS INJURIES

___________________________________________________________________________

1. COMPETITIOR'S DETAILS:

Given Names: ……………………………………………………….…………………...

Last Name: …………………………………………………………………………….

Date of Birth: .……...........…...

Address: ……………………………………………………………….………………...

State: ……...................Postcode: ....................... Country: ……………………………..

Ph (home).......................................Ph (work)…………………....………………...

Mobile / Phone: …………………………………………………………………………

Email: ………………………………………………………………………………….

2. WAIVER AND INDEMNITY

Applicant for him/herself, his/her executors, administrators, dependents and other personal representatives, hereby absolves and indemnifies the providers and all their servants, agents, employees and other students or persons under the providers control (the "indemnified") from all liability howsoever arising for injury or damage (including but not limited to the Applicants' person, whether fatal or otherwise, property and personal belongings) however caused including by the negligence of the indemnified, arising out of or participating in Martial Arts competition or in connection with Martial Arts or in any way caused by, or arising out of, any activity carried on by the indemnified. I, the Applicant, have been advised and understand that the practice of martial arts is potentially dangerous. I, the Applicant, agree to occupy and use the premises of the Kung Fu Wushu Australia Ltd (KWA) / Kung Fu Wushu Victoria (KWV) at risk to myself and release to full extent permitted by law The KWA / KWV, and its agents, servants, contractors and employees from all claims and demands of every kind in of or resulting from any accident or damage to property or injury or death to myself while participating in a martial arts competition/event/contest conducted by the KWA / KWV.

3. MEDICAL DECLARATION

I certify and acknowledge that I have NO physical disabilities or injuries that would impair my participation in any such competition or tournament and that I further certify that I do not suffer from any illness or blood related virus that may be transmitted to any other competitor, official or spectator. I declare that I have not been rendered semi or fully unconscious within the past four weeks from today’ date, and if prior to the event that I am rendered semi or fully unconscious I will notify the organiser and withdraw my registration.

4. MEDICAL TREATMENT

I consent to any emergency treatment that may be necessary as a result of any injury that I may sustain during the course of the tournament. I fully understand that any medical treatment provided to me as a response to injury, will be of FIRST AID type only and I am duly reasonable to arrange any transport at my own expense to a suitable medical centre or hospital if it is deemed the injury requires further treatment or in the event I have been rendered unconscious

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or unable I authorise for an ambulance to be called on my behalf to transport me to such a facility.

5. MARTIAL ARTS DONE AT APPLICANT'S OWN RISK

Any person participating at any martial arts contest/event/competition organised by the KWA / KWV are only allowed to do so on the distinct understanding that they do so entirely at their own risk.

6. ACCEPTANCE OF COMPETITION SURFACE I accept that the competition surface will not be of the same type and construction as those used in International events.

7. PERSONAL PROPERTY I accept that the neither the KWA / KWV nor its agents or employees shall be responsible for any loss or damage to such personal property or equipment that I may bring to the competition/event/contest.

8. USE OF IMAGE I hereby grant my consent for any photographic or video recording of my performance to be used by the KWA / KWV or any entity that the KWA / KWV so authorises. I agree that I will make waive entitlement to any payment or compensation for the use of my image and/or performance.

9. RULES AND REGULATIONS I hereby acknowledge that my Instructor/Coach has explained in full the rules of the competition and I undertake to abide by the rules, regulations and resolutions of the competition organisers as they may decide during the course of the competition.

10. STATEMENT OF UNDERSTANDING I, the Applicant have read, or have had read to me the above conditions and having understood the same, I consent to the activities proposed.

Signed (Applicant) ..................................................................................... Date .................................. [This application must be signed by a guardian if the Applicant is under the age of 18.] in the presence of (signature of witness) Name: ....................................................... Signed................................... Date ...............................

SCHEDULE 1 In addition to the Kung Fu Wushu Victoria Inc and Kung Fu Wushu Australia Limited., the providers in respect of this agreement include:

(a) All State and territory branches of the KWA

(b) All KWA staff, officials and volunteers, including but not limited to:

Walt Missingham

David Crook

Frederic Ong

(c) All KWV staff, officials and volunteers, including but not limited to:

Dana Wong

Shao ZhaoMing

Ian Hadfield

Bruce Corles