华夏智力运会报名表（分校）.doc

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1、2012华夏智力运动会报名表(_______________分校)报名费:$10/每人。每表限一人,每人限报一个单项。报名截止:2012/10/07,比赛日期:2012/10/21.8:30am-4:30pm比赛地点:Bridgewater-RaritanHighSchool,600GarretsonRoad,Bridgewater,NJ08807运动员姓名:NameinEnglish:运动员性别:男()/女()出生年月日(十五岁下须填写):YYYY/MM/DD:父/母姓名:父/母电话:()父/母电子邮件:项目(按成绩取前六名)

2、儿童组(2001.12.31后出生)少年组(97.01.01-2001.12.31)成人组(家长)围棋(Go)象棋(Xiangqi)国际象棋(Chess)五子棋(Wuziqi)国际跳棋(Checkers)----n/a----数独(Sudoku)----n/a----桥牌-----n/a----------n/a-----四国大战个人-----n/a----------n/a-----四国大战双人-----n/a----------n/a-----升级个人-----n/a----------n/a-----升级双人-----n/

3、a----------n/a-----ASSUMPTIONOFRISKANDRELEASEI,____________,allowmyson/daughter____________toparticipateinthefirstHuaxiaMindsportsGamewhichwillbeheldonOct,21st,2012atBridgewater-RaritanHighSchool,600GarretsonRoad,Bridgewater,NJ08807.Iunderstandthattherearerisksassoci

4、atedwiththeparticipationinthegame.Iunderstandtherisksincludepersonalinjury,disabilityandevendeath.Ivoluntarilyassumealltherisksinvolvedinparticipatinginthegame.IirrevocablyandunconditionallyreleaseandholdharmlessHuaxiaChineseSchool,includeallbranchschoolsandthoseacti

5、ngonitsbehalffromanyandalllawsuits,claims,andactionsarisingfromorconnectedwithmysonordaughter’sparticipationinthegame,failuretodeliveremergencymedicalservicesinapromptfashion,failuretoproperlyhandleamedicalemergencyinwhichmysonordaughterisinjured.Isignthisreleasewith

6、theintenttobelegallyboundbyit.Iamtheparentorlegalguardianof_______________.____________________________________________________SignaturePrintName