PIN-N-WIN WRESTLING CLUB., Inc.
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Registration (Spring/Summer 2018) Pin N Win Wrestling Club, Inc.
PLAYER INFORMATION
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First Name:
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Last Name:
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Street:
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City:
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State:
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Zip Code:
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Home Phone:
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Birthdate:
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Weight:
Email:
Gender:
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Grade:
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Adult
PARENT/GUARDIAN #1
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Firstname:
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Lastname:
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EMail:
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Home Phone:
Work Phone:
Cell Phone:
MEDICAL/EMERGENCY CONTACT INFORMATION
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Emergency Contact:
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Phone:
Relationship to Player:
Insurance Carrier:
Policy #:
WAIVER INFORMATION
*** Insert your waiver information here ***
WAIVER (Waiver and Release from Liability MUST be signed to wrestle)
1.On behalf of myself, my heirs and next of kin, personal representative, agents, insurers, successors and assigns (all hereinafter "Releasors") hereby FOREVER RELEASE, DISCHARGE AND COVENANT NOT TO SUE THE PIN N WIN WRESTLING CLUB, INC., its insurers, its affiliated clubs, administrators, agents, directors, officers, state organizations, members, committees, volunteers, all employees of Pin N Wrestling Club, and any and all participants, officials, referees, coaches, host clubs, sponsoring agencies, sponsors, advertisers, local organizing committees (and if applicable) owners, lessors and operators of premises used to conduct any PIN N WIN, USA and AAU Wrestling sanctioned event, meet, practice or activity (all hereinafter "Releasees") from any and all liabilities, claims, demands, causes of action or losses of any kind or nature, past, present or future, direct or consequential that I may hereafter have for PERSONAL INJURY, PERMANENT, TEMPORARY, TOTAL OR PARTIAL DISABILITY, DISFIGUREMENT, PARALYSIS AND ANY OTHER LOSSES OR DAMAGES TO PERSON OR PROPERTY OR DEATH, arising out of my participation in, attendance at or traveling to and from any PIN N WIN, USA and AAU Wrestling sanctioned event or activity including, but not limited to, LOSSES CAUSED BY THE PASSIVE OR ACTIVE NEGLIGENCE OF THE RELEASES, or hidden, latent or obvious defects in the facilities or equipment used.
2. Releasor understands and acknowledges that PIN N WIN,USA and AAU Wrestling sanctioned activities and the sport of wrestling in general have inherent dangers that no amount of care, caution, training, instruction, supervision or expertise can eliminate.
RELEASOR EXPRESSLY AND VOLUNTARILY ASSUMES ALL RISK OF PERSONAL INJURY, PERMANENT, TEMPORARY,TOTAL OR PARTIAL DISABILITY, DISFIGUREMENT, PARALYSIS AND ANY OTHER LOSSES OR DAMAGES TO PERSON OR PROPERTY OR DEATH, sustained while participating in, attending, preparing for or traveling to and from any PIN N WIN, USA and AAU Wrestling sanctioned event, meet, practice or activity, including the risk of PASSIVE OR ACTIVE NEGLIGENCE OF THE RELEASEES, or hidden, latent or obvious defects in the facilities or equipment used.
3. Releasor acknowledges and fully understands that each participant in any PIN N WIN, USA and AAU Wrestling sanctioned event, meet, practice or activity, including Releasor, will be engaging in activities that involve risk of serious injury, including permanent,temporary, total or partial disability, disfigurement, paralysis and any other losses to person or property, including death, and that severe social and economic losses may result not only from releasor's own action, inaction's or negligence, but also
from the actions, inaction's or negligence of other notwithstanding the rules of play or the condition of the premises or of any equipment used. Further Releasor acknowledges and fully understands that there may be other associated risks with such activities which are not known or not reasonably foreseeable at this time.
I ACKNOWLEDGE THAT I HAVE HAD SUFFICIENT OPPORTUNITY TO REVIEW THE PROVISIONS OF THIS DOCUMENT AND
UNDERSTAND ITS PURPOSE, MEANING AND INTENT.
I/we agree with the above
*
* required
New Member Initial Annual Registration Membership Fee (September 2017 - August 2018)($175)
Annual Renewal (Current Members) [September 2017-August 2018]($150)
Fall/Winter Training Session (September-February)($125)
Spring/Summer Training Session (March-August)($125)
Monthly Payment Plan($25)
Team Uniform /Shorts&Shirt($25)
Community Education Session (s) 12 Weeks($75)
Team T-Shirt($15)
Team Singlet($65)
Payments Accepted By
Note
: Credit Card information can be entered once this form is submitted