2012年第一届世界太极拳顶尖功夫王功夫后选拔大赛 参赛安全责任声明 我队选手共___名自愿参加2012年第一届世界太极拳顶尖功夫王功夫后选拔大赛，所有选手的身体状况经市级以上医院检查完全符合参加这次大会比赛的健康条件，比赛保险由参赛选手个人负责办理。在这次大会比赛中，如发生任何伤亡事故均为本人负责，选手家属或有关人员均不能状告马来西亚渊博陈式太极拳组委会或主、承办单位，不能以此为由提出索赔要求。我们同意，组委会有权无偿使用参赛选手参加大会的肖像。 特此声明， 代表队：____________________________________________________________ 团队负责人姓名：_________________________________签名：________________ 个人参赛者姓名：_________________________________签名：________________ 签署日期：_______________ 注：18周岁以下未成年参赛者，须有监护人签名 附：参赛安全责任声明人员名单（均须亲笔签字方能生效）：
2012年第一届世界太极拳顶尖功夫王功夫后选拔大赛 DECLARATION FORM I/We, am/are aware that my participation in the tournament involves certain amount of risks. I/We declare that we are physically fit to meet the challenges which the tournament demands. I/We further declare that I/We take part in this tournament with full knowledge of the consequences which may arise during the period of the tournament and shall therefore not hold the Organizes or their servants and agents responsible for any damage to or loss of property or any injury or loss of life which may be sustained by me/us during the tournament of arising from any cause in connection with the tournament where such damage to or loss of property of any injury of loss of life is not caused by the negligence or willful act or omission of the Organizers or their servants or agents. I/We declare to fully understood the above:- Name of Individual/Team: __________________________Sign：________________ Name of Team Leader (Group only): ________________ Sign：________________ Date：_______________ *Important – Participants under the age of 18 must obtain Parent/Guardian’s Consent
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