Wrestling Registration Form

Wrestler Information

Wrestler's Name

Date of Birth

Lives With

Parent/Guardian Information

Parent/Guardian's Name

Relationship

Address

Home Phone

Work Phone

Cell Phone

Email Address

USA Wrestling Medical Treatment Form

PARENT'S INSTRUCTIONS ON MEDICAL TREATMENT

Please print in capital letters

Emergency Contact

If an accident occurs and we are unable to reach you, please provide another contact:

Emergency Contact Name

Phone Number

Insurance & Medical Information

Insurance Company

Policy Number

Family Doctor

Doctor's Phone Number

Is your child presently on medication?

Drug Sensitivities

Other Allergies

Date of Last Physical Examination

Medical Consent

Please read the alternative statements below and sign under the one that you choose. Sign only one!

1. If my child needs medical attention, it is my wish that I am contacted before any medical procedures are taken on my child, unless immediate treatment is necessary to save my child's life or to prevent permanent injury.

Parent/Guardian Signature

Date Signed

2. If my child needs medical treatment while participating, it is my wish that the treatment is started while efforts are being made to contact me. I consent to any medical procedures the physician believes are needed, on the understanding that efforts to contact me will continue. I accept responsibility for all costs related to such treatment.

Parent/Guardian Signature

Date Signed

Additional Information

Wrestler's USA Wrestling Card No.

Name of Club

Coach's Name

Coach's Phone Number

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY WITH PARENTAL CONSENT ("AGREEMENT")

IN CONSIDERATION of being permitted to participate in any way in any event ("Activity") at any time during the current calendar year I, for myself, my personal representatives, assigns, heirs, and next of kin:

1. Acknowledgement

I ACKNOWLEDGE, agree, and represent that I understand the nature of the Activity and that I am qualified, in good health, and in proper physical condition to participate in such Activity. I further agree and warrant that if, at any time, I believe the conditions to be unsafe, I will immediately discontinue further participation in the Activity.

2. Understanding of Risks

FULLY UNDERSTAND that:

(a) THIS ACTIVITY INVOLVES RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS, AND DEATH ("Risks");
(b) these Risks and dangers may be caused by my own actions or inactions, the actions or inactions of others participating in the Activity, the conditions in which the Activity takes place, or THE NEGLIGENCE OF THE "RELEASEES" NAMED BELOW;
(c) there may be OTHER RISKS or SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation, or that of the minor in the Activity.

3. Release of Liability

I HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE the sanctioning organization(s), their administrators, directors, agents, officers, members, volunteers, and employees, other participants, officials, rescue personnel, sponsors, advertisers, owners and lessees of Premises on which the Activity is conducted, (each of the foregoing shall be considered one of the RELEASEES herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED, OR ALLEGED TO BE CAUSED, IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS; AND I FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, or anyone on my behalf, makes a claim against any of the Releasees, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expenses, attorney fees, loss, liability, damage, or cost which may be incurred as a result of such claim.

ACKNOWLEDGE THAT I AM OVER THE AGE OF 18 YEARS, HAVE READ THIS AGREEMENT AND FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE, AND I INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID, THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.

PRINTED NAME OF PARTICIPANT:

PARTICIPANT'S SIGNATURE:

ADDRESS:

PHONE:

DATE:

For Minors Under 18

Below section must be completed by Parent/Guardian for any participant under the age of 18.

I, THE MINOR'S PARENT AND/OR LEGAL GUARDIAN, UNDERSTAND THE NATURE OF THE ACTIVITY AND THE MINOR'S EXPERIENCE AND CAPABILITIES AND BELIEVE THE MINOR TO BE QUALIFIED, IN GOOD HEALTH, AND IN PROPER PHYSICAL CONDITION TO PARTICIPATE IN SUCH ACTIVITY. I HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS EACH OF THE RELEASEES FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON THE MINOR'S ACCOUNT CAUSED, OR ALLEGED TO BE CAUSED, IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE "RELEASEES" OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS AND FURTHER AGREE THAT IF, DESPITE THIS RELEASE, I, THE MINOR, OR ANYONE ON THE MINOR'S BEHALF MAKES A CLAIM AGAINST ANY OF THE RELEASEES NAMED ABOVE, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES FROM ANY LITIGATION EXPENSES, ATTORNEY FEES, LOSS LIABILITY, DAMAGE, OR ANY COST THAT MAY OCCUR AS A RESULT OF ANY SUCH CLAIM.

PRINT PARENT/GUARDIAN:

PARENT/GUARDIAN SIGNATURE:

ADDRESS:

PHONE:

DATE:

I HAVE READ THE RELEASE

RULES AND GUIDELINES FOR CLUB ACTIVITIES

A. HYGIENE

Hair - moderate length. No hair tonic.
Fingernails - clean and clipped short.
Body - bathed daily.

B. HEALTH

No dieting (wrestle at natural weight). Rapid weight loss is prohibited.
Cold or runny noses - STAY HOME!
Please bring all suspicious rashes to the attention of your coach.
Do not load up on food or beverages before practice.
Eat good healthy balanced meals.
No candy or chewing of gum at practice.

C. CLOTHES

Practices: shorts, t-shirts, sweat pants, tennis shoes (no street worn shoes) and without metal eyelets, no metal zippers - Singlet is optional.
Tournaments: Reversible red & blue singles required, all white socks (no stripes), white handkerchief is required and wrestling shoes (or high top tennis shoes - no metal eyelets and may not be used on the streets).
Do not wear any jewelry while wrestling.
No wrestling will be allowed in street clothes.

D. PRACTICES

Monday,Tuesday,Thursday. Please be prompt in bringing your wrestler to practice. If you are going to be late please alert your coach. All wrestlers MUST stretch and warm up.
Wrestler will help lay and remove all mats.
Wrestlers will help in sanitizing mats 1-2 times a week.

E. CONDUCT AND ATTITUDE

Wrestler must show a desire to wrestle.
NO HORSE PLAY! No kicking, hitting, tripping or jumping on others at any time.
Wrestlers are to report to their coach in the wrestling room. They will not be allowed to leave without permission from their coach. Wrestlers will be given supervised restroom and water breaks at the appropriate time by their coaches.
Wrestlers are expected to listen and follow instructions of their coaches.
When doing warm-up drills, calisthenics, and running, wrestlers are expected to do them all and perform them properly.
Any wrestler playing around and not practicing will not be allowed to finish the rest of practice. They will sit on the sidelines and watch.
TANTRUMS, PROFANITY OR OTHER BAD SPORTSMANSHIP WILL NOT BE TOLERATED!
DISCIPLINE will be handled by coaches and/or board members. Any wrestler disrupting practice will be told to do push-ups, sit-ups or run laps. For extreme situations the wrestler may be expelled from the club.
DESTRUCTION OF ANY PROPERTY OR STEALING AT ANY CLUB ACTIVITY WILL RESULT IN BEING EXPELLED FROM THE CLUB.
Our goal is to work together to be a great team!!

F. PARENT INVOLVEMENT AND CONDUCT

VOLUNTEERING: The club encourages parents to get involved.
Become mat officials or pairing officials - help at tournaments as scorekeepers, timers or runners.
Help with fundraising and other committees.
Parents are asked to help in disinfecting and care of the mats.
SPORTSMANSHIP: Starts with you. Help us teach good sportsmanship and positive self-esteem by setting a good example.
Verbal and physical abuse to your child will not be tolerated.
Abuse to volunteers (officials) will not be tolerated.

G. PROBLEMS OR CONCERNS

Parents are welcome and encouraged to talk with coaches before or after practice about any problems or concerns.

Acknowledgment

Bottom portion must be signed and returned to a Board Member or Coach before the first tournament.

I have read and will comply with the RULES AND GUIDELINES FOR CLUB ACTIVITIES.

Print Parent/Guardian's Name:

Date:

Parent/Guardian's Signature:

Print Wrestler's Name:

Wrestler's Signature:

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