ASOY 09 Form draft 090527 - United States Judo Federation

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(Please use Acrobat Reader to complete form)4. Head Instructor’s Character Endorsement (written by Head Instructor):_________________________________________________________Head Instructor’s Signature______________DatePage 4 of 5USJF Form 579, V2.0.1, 090527
(Please use Acrobat Reader to complete form)5. Any other information you would like to furnish the committee:Under penalties of perjury, I declare that the statements and answers in this application, together withmy transcript and other information supplied in connection with my application, are to the best of myknowledge and belief, true, correct, and complete. If there is any material error or omission in thisapplication as determined in the sole discretion of the USJF Athlete-Scholar of the Year Committee(Committee), I understand that the Committee may withhold and/or require the return of any prizeand/or scholarship I received and I agree to fully cooperate upon request of the Committee.PHOTO & ESSAY RELEASEFor Individuals Over The Age Of MajorityFor and in consideration of the scholarship monies that may be paid to, received, and herebyacknowledged by me, state I am over the age of majority and hereby consent to United States JudoFederation, Inc. using my submitted essay and photographs containing my image in commercial andnon-commercial presentations for educational, informational, and promotional purposes.For Individuals Under The Age Of MajorityFor and in consideration of the scholarship monies that may be paid to, received, and herebyacknowledged by the Applicant, state I am the parent/legal guardian of the Applicant and do herebyconsent to United States Judo Federation, Inc. using the Applicant’s submitted essay andphotographs containing images of the Applicant in commercial and non-commercial presentations foreducational, informational, and promotional purposes. I will hold United States Judo Federation, Inc.harmless from any claims made by the Applicant for the above stated use before and after theApplicant reaches the age of majority._________________________________________________________Applicant’s Signature_________________________________________________________Parent/Legal Guardian’s Signature (if applicant is under 18 years of age)_________________________________________________________Head Instructor’s Signature________________Date________________Date________________DateDecisions of the ASOY Committee will be final in all mattersPage 5 of 5USJF Form 579, V2.0.1, 090527
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ASOY 09 Form draft 090527 - United States Judo Federation

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