Ossining Wrestling Club

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2018 - 2019 Ossining Youth Wrestling Club Registration

WRESTLER INFORMATION

* First Name:

* Last Name:

* Spirit Pack T- Shirt Size:

* Spirit Pack Shorts Size:

* Street:

* City:

* State:

* Zip Code:

* Home Phone:

* Cell Phone:

* Birthdate:

* Email:

* Gender:

* Grade:

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

* EMail:

* Parent Home Phone:

Parent Cell Phone:

PARENT/GUARDIAN #2:

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

* Insurance Carrier:

Policy #:

WAIVER INFORMATION

In consideration of my acceptance of this application I give my child permission to enter this club at his/her own risk. I hereby release any and all claims I may have against the coaches,officials, referees, sponsors, volunteers, Larry McRae, the Ossining Wrestling Club or Ossining Union Free School District and its employees as well as USA Wrestling from any liability for any injuries or losses suffered directly or indirectly as a result of traveling to and from, practicing or competing in the Ossining Wrestling Club.
AND 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 RELEASEE'S 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 CLAIMS 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.
I/we agree with the above !

I/we agree with the above *

* Parent Signature:

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2018 - 2019 Ossining Youth Wrestling Club Registration