Rogers Area Wrestling Club
Wrestler’s Name:________________________________
Birthdate:__________ Grade:__________
Parent/Guardian Name:___________________________________
Address:_________________________________________________________________________________
Phone#:_____________________________________
Email Address:____________________________________
Emergency Contact Name:___________________________________
Phone#:___________________________________
T-Shirt Size YM(10-12) YL(14-16)
AM AL AXL AXXL($2.00 xtra)
1st Shirt Free for wrestlers, Additional Shirts $10.00.
$125.00 CK#:_____________Make Check Payable To:
Rogers Youth Wrestling Club
“USA Wrestling Waiver & Release from Liability Form”
Completed and Signed?: Y or N
(Waiver on the back of this page.)
Do we have your permission to publish or exchange your name, address, phone number, email address and photograph?: Y or N
Parent or Guardian Signature:______________________Date______
USA Wrestling
Waiver and Release from Liability
1. I, _______________________________, the undersigned, on behalf of myself, my heirs and next of kin, personal representative, agents, insurers, successors and assigns (all hereinafter "Releasers") hereby FOREVER RELEASE, DISCHARGE AND COVENANT NOT TO SUE THE UNITED STATES OF AMERICAN WRESTLING ASSOCIATION, INC., its insurers, its affiliated clubs, administrators, agents, directors, officers, state organizations, members, committees, volunteers, all employees of USA Wrestling, 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 USA Wrestling sanctioned event, meet, practice or activity (all hereinafter "Releases") 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 USA Wrestling sanctioned event or activity including, but not limited to, LOSSES CAUSED BY THE PASSIVE OR ACTIVE NEGLIGENCE OF THE RELEASEES, or hidden, latent or obvious defects in the facilities or equipment used.
2. Releaser understands and acknowledges that USA 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 USA 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. Releaser acknowledges and fully understands that each participant in any USA Wrestling
sanctioned event, meet, practice or activity, including Releaser, 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 releaser’s own action, inactions or negligence, but also from the actions, inactions or negligence of other notwithstanding the rules of play or the condition of the premises or of any equipment used. Further Releaser acknowledges and fully understands that there may be other associated risks with such activities that 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.
_______________________________________ _____________ ________________________
(Participant's Signature) (Date) (Print Name)
The undersigned,________________________does hereby represent that he/she is, in fact, the parent or legal guardian of_________________________and acting in such capacity agrees to the terms and conditions of the above stated waiver and release.
_______________________________________ _____________ ________________________
(Signature of parent or legal guardian) (Date) (Print Name)
_______________________________________
(Relationship to minor)