Litchfield Youth Wrestling

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2019-2020 LYW Registration

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

* Birthdate:

* Grade:

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

* EMail:

* Home Phone:

Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

Insurance Carrier:

Policy #:

WAIVER INFORMATION

FRIENDS OF LITCHFIELD YOUTH RELEASE OF LIABILITY FOR PERSONAL INJURY

I ________________________________ do hereby release Litchfield Youth Wrestling and the Litchfield School District, the Litchfield Recreation Department, its owners, operators, instructors, coaches, employees, agents and servants, from any and all liability for personal injury to me or my child and or the athlete that I am registering, and/or ward as the result of any negligence arising out of or in the course of or in any way related to me or my child’s use of the facilities, equipment, apparatus or premises of Campbell high school and Litchfield Youth Wrestling and /or my or my child’s participation in other events organized, run and/or sponsored by Litchfield Youth Wrestling whether at practice tournaments, fund raisers or elsewhere. On behalf of myself and my Child, I agree to indemnify and hold harmless the said claims, demands, costs, expenses and compensation arising out of or in the course of or in any way related to any personal injury to me or my child.
By signing this release, I acknowledge my understanding and acceptance of the following:
1. Any sport requires strength, agility and concentration and that it is solely my responsibility to determine that my child is in good health and good physical and mental condition before permitting my child to exercise, work out, receive instruction or perform.
2. That any sport that requires twisting, turning, tumbling, jumping, flexion, extension and rotation, which movements are often performed with considerable force and/or at considerable height and which can result in severe, permanent personal injuries, including, but not limited to, bruised, strained, sprained or torn muscles, tendons and ligaments, broken bones, derangements or dislocations of joints, concussion, brain damage, nerve and spinal cord injury, paralysis and death.
3. That all sports require the use of apparatus and/or equipment, which may cause or contribute to severe, permanent personal injuries, such as those described above.
4. No persons (students, parents, or any other personnel) allowed inside with any materials including but not limited to, matches or lighters, which may cause a fire in the gymnasium. I have read and understand the Release of Liability for Personal Injury.

* Name of Parent / Guardian:

* Name of Wrestler:

I/we agree with the above *

Signature:

Date:

Signature:

Date:

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2019-2020 LYW Registration