General Information

WAKO INDIA 3rd WEST BENGAL STATE KICKBOXING CHAMPIONSHIP–2023
(Men & Women – All Events)

Date: 28th,29th & 30th April 2023
At: MELA GROUND, KALIMPONG
Organized By: WEST BENGAL SPORTS KICKBOXING ASSOCIATION
Hosted by:Karkriti Kickboxing Association, Kalimpong
Affiliated with : West Bengal Sports Kickboxing Association
Member: WAKO INDIA Kickboxing Federation
GENERAL INFORMATION
Organizer KARKRITI KICKBOXING ASSOCIATION, KALIMPONG
Contacts Mr. YOURAJ RAI
General Secretary
Mob. No.+91 6296941723
E. mail: karkritikickboxing@gmail.com
Date 28th ,29th & 30th April 2023
Venue Mela ground, Kalimpong
Spot Registration Kindly submit following at Registration counter:-

A. Original Copy of Waiver Form with photos,
B. Age proof certificates
C. Medical Certificate
D. Spot Registration can be done ONLY on 28th April 2023 from
10.00 AM to 04.00 PM.
Important A. No team will be taken once the Registration time is over.

Information: B. Athlete / Official Card, Accommodation and Food coupons shall be
provided, only after registration with all entry forms done.
C. West Bengal Sports Kickboxing Association shall not be liable for any
wrong / false and misleading information submitted by the participants.
D. Participants shall be subjected to random dope test at any time before /
during / later the events as per the notifications issued by MYAS/NADA
Govt. of India.
Fees A. Entry Fees Rs. 1700/- only

B. For Sports Pass Rs. 300/- only (mandatory)
C. Without Sports Pass no one will allow for the registration.
D. Team Registration Rs. 1000/- only
E. Team Security deposit Rs. 2000/- only ( fund will be refunded if there is no
fault)
F. For Extra event fee Rs. 500/- only.
Address: Purba Saradapally, Kadamtala, Siliguri, Dist. Darjeeling-734011, West Bengal, INDIA
Phone No. +91 9832458241 E. mail: wakoindiabengal@gmail.com
Accommodation –  Accommodation will be provided for Three nights starting from 28th , 29th
Check in & Check & 30th April 2023.
Out  Check-in will start at 02.00 PM on 28th April 2023 only after registration
is done.
st
 Check-out shall start at 7.00 am and should be finished by 11.00 am on 01
May 2023.
Food  Breakfast will be provided for 29th & 30th April 2023
 Lunch will be provided for 29th & 30th April 2023.
 Dinner will be provided for 28th , 29th & 30th April 2023.
Liability A. Please note that the Organizers or any of its Officials or Members shall not
be liable or responsible for any personal injury, for any loss or damage to
your property arising out of your participation and travelling in connection
with this event.
B. Any team arriving earlier or departing later, then the Organizer/Association
shall not be responsible for their food & accommodation.
Referee Selected WAKO Bengal Licensed Referee/Judge Panel will get a total
Remuneration remuneration as below for this event of four days:-
‘A’ Grade - Rs. 1500/-
‘B’ Grade - Rs. 1000/-
‘C’ Grade - Rs. 500/-
Uniform & A. All players must carry their own Uniforms & Safety Equipments.
Equipment B. Only WAKO Bengal approved Uniform & Safety Equipments shall be
allowed during the competition.
C. All Referees must be in their dress code as per prescribed by WAKO Bengal
during the Championship.
D. Team Managers / Coaches / Referees / Kickboxing shall be in their
Ceremonial / Sports Kit at the time of Opening & Closing Ceremony.
Certification All Participants will be awarded with Participation & Merit Certificates.
Medals All winners will be awarded Gold, Silver & 2 Bronze Medals as per their events
/ categories.
TENTATIVE SCHEDULE
Date Day Time Program

10.00am to 04.00pm Arrival of Teams & Registration.
28/04/2023 Friday 10.00am to 04.00pm Medical, Weighing & Draw / Fixtures
07.00pm to 08.00pm Team Managers / Coaches Meeting
07.30pm to 09.00pm Dinner
07.00am to 08.00am Breakfast
29/04/2023 09.00am Event starts

Saturday 01.00pm to 02.00pm Lunch
03.00pm to 04.00pm Opening Ceremony
07.00am to 08.00am Breakfast
01.00pm to 02.00pm Lunch
30/04/2023 Sunday 04.00pm to 05.00pm Medal Ceremony
05.00pm to 06.00pm Cultural Program
Subject to be changed!

Waiver of Liabilities
(Fill in CAPITAL LETTERS)
1) District/UT Asso:
2) Participant Name:
3) DOB: Age: Male/Female
4) Weight: Kg: Events:
5) I am (tick mark in appropriate box):
i) Player Affix your

ii) Team Manager photograph
iii) Coach
iv) Referee/ Judge
F. I the undersigned knowingly and

without compulsion / duress do voluntarily submit my entry to compete/participate in WAKO INDIA 3rd
West Bengal State Kickboxing Championship – 2023 (Men & Women) from 28th , 29th & 30th April 2023
at Mela Ground ,Kalimpong, subject to the acceptance of my participation by the organization
committee/Association. 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 organizer
responsible nor my Home Association/Unit for the same. I agree to abide by the Rules and Regulations of
the Organizing Committee / West Bengal Sports Kickboxing Association. I further agree that in the
event of any protest, it must be conducted in accordance with the Rules and Regulations. I have read and
fully understood the waiver listed above and the bio data given by me is true to the best of my knowledge.
West Bengal Sports Kickboxing Association shall not be liable for any wrong, false and misleading
information submitted by me.
Recommended by Signature of the Participant

President/Secretary District/Unit Assn.
………………………………………………………………………………………………………………………………...……
MEDICAL CERTIFICATE
I, the undersigned, hereby certify that ………………………………………………………………………..
has undergone medical examination under my observation and he/she is physically & mentally fit for
Kickboxing sport.
Fitness Recommended by
Licensed Doctor with sign & seal
Phone No. +91 9832458241; E. mail: wakoindiabengal@gmail.com
Date: 28th, 29th & 30th April 2023

APPLICATION FORM FOR

ACCOMMODATION & TRANSPORTION FROM NJP RAILWAY STATION & BACK
APPLICABLE FOR GROUP OF MINIMUM 05 PEOPLE AND MORE ONLY
DISTRICT/UNIT:
NAME OF ASSO:……………………………………………………………………………………………
TEAM LED BY/CONTACT PERSON NAME:…………………………………………………………….
MOBILE: 1. ................................................................... 2.
DISTRICT/UNIT CONTACT DETAILS:
PRESIDENT/SECRETARY NAME:
TEL. FAX:
E-Mail:
DO YOU WANT TRANSPORT? YES NO
DATE OF ARRIVAL:
DATE OF DEPARTURE:
ARRIVAL TRAIN NAME AND NUMBER:
DEPARTURE TRAIN NAME AND NUMBER:
NUMBER OF DELEGATION:
Extra /
Players Referee Team Coach Team Manager TOTAL
Guests
Male Female Male Female Male Female Male Female Male Female
Total Vegetarian Participants:
Total Non-Vegetarian Participants:
PLEASE RETURN THIS FORM BEFORE 15TH APRIL 2023
BY E-MAIL TO: wakoindiabengal@gmail.com
NO FORM RECIEVED ONLINE MEANS - NO TRANSPORTATION FOR YOUR DELEGATION
Phone No. +91 9832458241; E. mail: wakoindiabengal@gmail.com

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WAKO INDIA 3rd WEST BENGAL STATE KICKBOXING CHAMPIONSHIP–2023

(Men & Women – All Events)

Date 28th ,29th & 30th April 2023

Venue Mela ground, Kalimpong

Spot Registration Kindly submit following at Registration counter:-

Important A. No team will be taken once the Registration time is over.

Fees A. Entry Fees Rs. 1700/- only

Date Day Time Program

07.00am to 08.00am Breakfast

29/04/2023 09.00am Event starts

Date: 28th,29th & 30th April 2023

i) Player Affix your

F. I the undersigned knowingly and

Recommended by Signature of the Participant

Date: 28th, 29th & 30th April 2023

APPLICATION FORM FOR

APPLICABLE FOR GROUP OF MINIMUM 05 PEOPLE AND MORE ONLY

Total Vegetarian Participants:

Total Non-Vegetarian Participants:

PLEASE RETURN THIS FORM BEFORE 15TH APRIL 2023

BY E-MAIL TO: wakoindiabengal@gmail.com

NO FORM RECIEVED ONLINE MEANS - NO TRANSPORTATION FOR YOUR DELEGATION

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