KHELO INDIA WOMEN’S KICKBOXING LEAGUE 2023-24

(Cadets, juniors, Seniors & Masters – All Events)

Date: 07th & 08th October 2023
At: Late. Vithoba Maruti Pathare Sports Complex, Kharadi, Pune

Waiver of Liabilities

(Fill in CAPITAL LETTERS)

Khelo India ID No.

1) State/UT Asso: Affix your

2) Participant Name: photograph

3) Daughter Of:____________________________________________________

4) DOB: Age: Gender

5) Weight: Kg Events:

1) I am (tick mark in appropriate box):

i) Player ii) Team Manager iii) Coach iv) Referee/ Judge

I the undersigned knowingly and without

compulsion / duress do voluntarily submit my entry to compete/participate in Khelo India Women’s
Kickboxing League, Cadets, Juniors, Seniors & Masters 7th & 8th October 2023, at Late Vithoba Maruti
Pathare Sports Complex, Kharadi, Pune subject to the acceptance of my participation by the organization
committee/Federation. 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 / WAKO India Kickboxing Federation & Sports authority of India (SAI). 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.

Recommended by Signature
President/Secretary State/UT Assn.
For a Kickboxer under the age of 18 signature of Parent or Legal Guardian
……………………………………………………………………………………………………………
MEDICAL CERTIFICATE
I, the undersigned, hereby certify that ………………………………………………………………..
Has undergone medical examination under my observation and she is physically & mentally fit for
Kickboxing sport.

Fitness Recommended by
Licensed Doctor with sign & seal Date:

Address: Administrative Office: Basement, J-3180, Sainik Colony, Sector-49, Faridabad-121001, Haryana, INDIA
Phone No. 0129-4155205; E. mail: wakoindiainfo@gmail.com