2013 victorian kung-fu wushu championships 6 - australian kung

2013 Victorian Kung-Fu Wushu Championships

6th October 2013

Knox Indoor Stadium 108 Lewis Road

Wantirna South, Victoria

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) ..................................................... 12

SEROLOGY REPORT (SANDA FULL CONTACT) ............................................................... 17

APPLICATION INDEMNIFICATION WAIVER FORM TO PARTICIPATE ............................. 18

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2013 Victorian Kung-Fu Wushu Championships

GENERAL INFORMATION

1. Championship Date Sunday 6th October 2013 9:00 am – 4:00pm (Registration 8:00am) The Championship Organising Committee reserves the right to make changes to the programme which are deemed fit.

2. Championship Venue

Knox Indoor Stadium 108 Lewis Road Wantirna South, Victoria

3. Competitors Qualification For Entry

(a) Members and non-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.2013vicstate.eventbrite.com.au

(c) Closing date for internet registration is Saturday, August 24 2013. Online entries must be received by this date. Late entries will not be accepted.

(d) Competitors must also submit the signed Waiver Form by the registration closing date and 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.

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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:

President Kung Fu Wushu Victoria: Dana Wong Email: [email protected]

Sparring Event Coordinator: Bruce Corles Email: [email protected]

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 this 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

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- one weapon event - 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 4

th minute.

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

th minute.

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

th minute.

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

rd minute.

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

rd 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.

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• 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. (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 Australian Dollars

KWA Members Non-Members

First individual routine event $40 per person $48 per person Second individual routine event $15 per person $18 per person Duel routine event $15 per person $18 per person Group routine event $10 per person $12 per person

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SPARRING COMPETITION RULES AND REGULATION

1. Championship Events and Age Divisions

(a) Point Sparring Events and Continuous Sparring Events • Age Divisions - 7 years and under - 8 to 9 years old - 10 to 11 years old - 12 to 13 years old - 14 to 15 years old - 16 to 18 years old

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

• Weight Classes: - Men (Youth): below (kg): 48, 52, 56, 60, 65, 70, 75, 80 - Women (Youth): below (kg): 48, 52, 56, 60 - Men (Adult): below (kg): 48, 52, 56, 60, 65, 70, 75, 80, 85, 90 over 90kg - Women (Adult): 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. This will require the full agreement of the Team Manager, Team Coach and Sanda Athletes/s concerned

2. Participation Methods

(a) Point Sparring Events and Continuous Sparring Events

• Each competitor may register and compete in both point sparring and continuous sparring events.

• The competitor cannot compete in the sanda full contact event.

(b) Sanda Full Contact Sparring Events • Each competitor may only enter in 1 (one) weight category. • The competitor cannot compete in the point sparring or continuous sparring events.

3. Relevant Rules

(a) Point Sparring Events

• The competition shall be Individual Competition. • The competition shall be Light Contact to the body and Non Contact to the head and

face. Light Contact means slight penetration or slight target movement as a result of a technique. Non Contact means no contact with the opponent as a result of a technique that stops short 7 cm from the target area.

• Protocol: Upon hearing the name of the division called, all competitors must line up at the arena designated. The referee will call all competitors to stand, bow to the referee and the officials table. Competitors will be seated along side of the arena and remain there

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until the event is finished or they are called to compete. At the end of the event all competitors will bow to the referee and officials table.

• Winner is decided by best of three (3) rounds. Each round to last a maximum of sixty (60) seconds.

• The competitor wins the round by either:

- Earning a three (3) point advantage over the opponent;

- Being the first to win five (5) points; OR

- Having the most points if no one scores (five) points or a three (3) point advantage by

the end of round,

• In the case of a draw, competitors will continue the round and the first competitor to score a point wins.

• One (1) point will be awarded on clean striking techniques.

• A competitor cannot score a point if he has one foot out of the ring.

• Scoring areas: The torso above waist height, shoulders, head and face.

• All strikes to the body must be pulled using light contact.

• Any technique to the head and face to be non contact only. Strictly no contact to the face. Techniques must stop short of the head and face. 7 cm halo applies to the entire head area.

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

• Fighting Methods: - Hand and leg techniques not directed at the back of the head, neck, spine and

anywhere below the waist. All contact should be made by the padded side of the glove or boot.

• Prohibited Methods: - Making contact with the opponent’s head, face, neck, spine and anywhere below the

waist.

- Attacking with the head, the forearm, palm, fingers, elbow or the knee. - Takedowns, sweeps and throws.

- Any excessive or uncontrolled attacks.

• Penalties - 1

st penalty = warning.

- 2

nd penalty = one (1) point to his opponent.

- 3

rd penalty = instant disqualification.

- Excessive contact will result in penalty points or disqualification.

- Continual stepping outside the ring area will result in penalties.

- Excessive contact, brawling, poor sportsmanship, striking to non-target areas whether

malicious or unintentional or arguing with the referee will result in immediate disqualification without warning at the referee’s discretion. The competitors will also lose their placing.

(b) Continuous Sparring Events

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• The competition shall be Individual Competition. • The competition shall be Light Contact to the body and Non Contact to the head and

face. Light Contact means slight penetration or slight target movement as a result of a technique. Non Contact means no contact with the opponent as a result of a technique that stops short 7 cm from the target area.

• Protocol: Upon hearing the name of the division called, all competitors must line up at

the arena designated. The referee will call all competitors to stand, bow to the referee and the officials table. Competitors will be seated along side of the arena and remain there until the event is finished or they are called to compete. At the end of the event all competitors will bow to the referee and officials table.

• Winner is decided by best of three (3) rounds. Each round to last sixty (60) seconds.

• Points: Only for 9 years and below. - One (1) point will be awarded on clean striking techniques.

• Points: Only for 10 years and above. - Points will be awarded on clean striking techniques.

- Two (2) points will be awarded when the competitor:

a. Forces his opponent out of the arena and he remains in the arena. b. Takes down his opponent by a controlled sweep or takedown and remains

standing. c. Successfully attacks his opponent’s head or torso with a leg technique.

- One (1) point will be awarded when the competitor: a. Takes down his opponent by a controlled sweep or takedown and goes down with

him. This includes grounding as part of the controlled sweep or takedown. b. Successfully attacks his opponent’s head or torso with a fist technique. c. Successfully attacks his opponent’s thigh with a leg technique.

- One (1) point will be awarded if the opponent accidentally steps out of the arena.

• A competitor cannot score a point if he has one foot out of the ring.

• Scoring areas: Only for 9 years and below. - The torso above waist height, shoulders, head and face.

• Scoring areas: Only for 10 years and above. - The torso above waist height, thighs, shoulders, head and face.

• All strikes to the body must be pulled using light contact.

• Any technique to the head and face to be non contact only. Strictly no contact to the

face. Techniques must stop short of the head and face. 7 cm halo applies to the entire head area.


• Fighting Methods: Only for 9 years and below. - Hand and leg techniques not directed at the back of the head, neck, spine and

anywhere below the waist. All contact should be made by the padded side of the glove or boot.

• Fighting Methods: Only for 10 years and above. - Hand and leg techniques not directed at the back of the head, neck, spine, groin and

inside part of the leg. All contact should be made by the padded side of the glove or boot.

- Outside leg kicks and controlled sweeps and takedowns that would not result in a neck

or spinal injury.

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- Competitors may catch kicks and sweep.

• Prohibited Methods: Only for 9 years and below. - Making contact with the opponent’s head, face, neck, spine and anywhere below the

waist.

- Attacking with the head, the forearm, palm, fingers, elbow or the knee.


- Takedowns, sweeps and throws.

- Twisting the opponent’s joints.

- Clinches.

• Prohibited Methods: Only for 10 years and above. - Making contact with the opponent’s head, face, neck, spine, groin and inside part of

the leg.

- Attacking with the head, the forearm, palm, fingers, elbow or the knee.


- Throws.

- Inside leg kicks.


- Forcing the opponent to fall head over heels from above shoulder level. This means lifting the opponent above shoulder level and throwing him down.

- Intentionally smashing the opponent head first into the ground.

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

- Clinching for more than two (2) seconds.

- Striking when clinching.

• Penalties - 1

st penalty = warning.

- 2

nd penalty = one (1) point to his opponent.

- 3

rd penalty = instant disqualification.

- Excessive contact will result in penalty points or disqualification.

- Continual stepping outside the ring area will result in penalties.

- Excessive contact, brawling, poor sportsmanship, striking to non-target areas whether

malicious or unintentional or arguing with the referee will result in immediate disqualification without warning at the referee’s discretion. The competitors will also lose their placing.

(c) Sanda Full Contact Sparring Events

• The competition shall be Individual Competition. • The competition shall be Full Contact.

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• The knock out 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 of each round shall be 1 minute 30 seconds.

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


• Fighting Methods: - 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.


- Forcing the opponent to fall head over heels from above shoulder level. This means

lifting the opponent above shoulder level and throwing him down.

- Intentionally smashing the opponent head first into the ground.

- Hitting the opponent’s head by any means when he is down. 4. Competitors Costume, Uniform, Foot Wear & Equipment

(a) Point Sparring and Continuous Sparring Events

• All competitors must provide their own sparring equipment. This includes mouth guard, groin guard, gloves, shin and foot protectors. It is recommended that competitors use WKF approved typed equipment.

• 6 oz. minimum weight gloves (boxing gloves) and have 25mm knuckle padding.

• Foot protectors must cover the instep.

• No cloth style gloves or cloth style foot protectors allowed.

• Chest protectors for females and headgear for all competitors will be provided.

• All competitors must wear clean and neat club uniforms. (No Thai boxing shorts or singlets)


(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.

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5. Weighing-in

Sanda Full Contant Sparring Events

• The weighing-in will take place on the Saturday October 5th 2013 at the Championship

venue. Time of weigh-in to be advised.

• 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.

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 3

rd Equal Place Bronze Medal(s)

7. Championship Fees

Australian Dollars Australian Dollars

KWA Members Non-Members

First sparring event $40 per person $48 per person Second sparring event $15 per person $18 per person

*** Competitors competing in sanda cannot compete in point or continuous sparring. ***. *** Competitors competing in point or continuous sparring cannot compete in sanda. ***

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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 T Other _________________________________________

ii. Hepatitis B Antigen Negative or immune T Other ____________________________

iii. Hepatitis C Negative T 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 2013 VICTORIAN KUNG-FU WUSHU CHAMPIONSHIPS

6th October 2013

Knox Indoor Stadium

PARTICIPATING IN A MARTIAL ARTS TOURNAMENT IS DANGEROUS

AND CAN CAUSE SERIOUS INJURIES ___________________________________________________________________________

1. COMPETITIOR'S DETAILS:

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

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

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

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

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

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

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

Occupation: ................................................................... Date of Birth: .……...........…...

Name of Employer: ……………………………………………………………………

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. 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.

4. ACCEPTANCE OF COMPETITION SURFACE I accept that the competition surface will not be of the same type and construction as

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those used in International events.

5. 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.

6. 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 no claim for the use of my image and/or performance.

7. 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)

...................................................................................................................

This (date) ....................... day of

(month)................................................................20.......... in the presence of (signature of witness)

.................................................................................

[This application must be signed by a guardian if the Applicant is under the age of 18.]

SCHEDULE 1

In addition to the Kung Fu Wushu Victoria Inc., the providers in respect of this agreement include:

(a) The Management, staff and owners of Knox Indoor Stadium.

(b) All State and territory branches of the KWA

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

Walt Missingham

David Crook

Frederic Ong

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

Dana Wong

Shao ZhaoMing

Ian Hadfield

Bruce Corles

2013 victorian kung-fu wushu championships 6 - australian kung

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