Kalispell Wrestling Club Registration Form 2010
Last First Mi. .
Parent/Guardian .
Alternate Contact .
Wrestler’s Address: .
Wrestlers Contact Phone Number .
Birth date: . Email address: .
General Release
I do hereby give my consent to the participation in any and all activities of the current wrestling season. I do assume all risks and hazards incidental to the conduct of said activities. I do further release, absolve indemnity, and hold harmless, the Kalispell Wrestling Club, the sponsors, organizers, and the coaches In case of injury to my child, and hereby waive all claims against the organizers and sponsors appointed by them. I release from responsibility, any person transporting my child to and from any club activity. I further agree to abide by the constitution and by-laws of USA Wrestling.
___ I authorize the Kalispell Wrestling Club to place pictures and video of my wrestler on the club’s website.
***As parent or legal guardian of the above named wrestler, I hereby give my consent for emergency medical care prescribed by a duly licensed doctor of medicine or dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb or well being of my dependent.
Signed Relationship Date___________
___ I am interested in coaching Name Phone #
All Coaches are required to complete a background check as per the 2010 USAW National Rules
********AUTHORIZED PERSONNEL TO FILL OUT THE REST OF THIS FORM***********
*****Attach to copy of birth certificate
Birth Certificate Yes No
Registration $___________ cash / check#____________
USA Card $___________ cash / check#____________
Singlet Size Weight T Shirt size
Deposit $ Cash/Check#
