Siegel Community Wrestling Club

Registration Form

Wrestler’s Name: _____________________________________________________________

First Middle Last

Date of Birth: _____________________________ Age as of Jan 1st 2019______________

Grade: ________ Approx. Weight ____________ Best Phone # ____________________

Address: ____________________________________________________________________

City: _____________________________________________ Zip: _____________________

Parent/ Guardian #1 _____________________________ Phone ______________________

P/G #1 Email: ________________________________________________________________

Parent/ Guardian #2 _____________________________ Phone ______________________

P/G #2 Email: ________________________________________________________________

Has your child ever wrestled before? Y / N Years of experience: _________________

Siegel Community Wrestling Club
Medical Consent Form
Wrestler’s Name: _____________________________________________________________
First Middle Last

Date of Birth: _____________________________ Age: ___________________________

Address: ____________________________________________________________________

City: _____________________________________________ Zip: _____________________

Parent/ Guardian #1 _____________________________ Phone ______________________

Parent/ Guardian #2 _____________________________ Phone ______________________

Allergies: ____________________________________________________________________

Medical Conditions: ___________________________________________________________

_____________________________________________________________________________

Emergency Contact (other than guardians listed): __________________________________

Primary Phone: _______________________ Secondary Phone: ______________________

Email: ______________________________________________________________________

MEDICAL CONSENT
In the event that my child needs medical treatment while participating, it is my wish that
treatment is started while efforts are made to contact me. So that treatment is not delayed, I
hereby grant permission to the Siegel Community Wrestling Club and its coaches to provide
consent for treatment to any medical procedures that the physician believes are needed, on the
understanding that efforts to contact me will continue to be made. I accept responsibility for all
cost related to such treatment.

Parent / Guardian Signature: ___________________________________________________

Date: _______________________
Siegel Community Wrestling Club
WAIVER AND RELEASE OF LIABILITY

1. I, (Parent / Guardian) ____________________________________________________, the undersigned,

on the behalf of myself, my heirs, and next of kin, hereby FOREVER RELEASE, DISCHARGE, AND
COVENANT NOT TO SUE THE SIEGEL COMMUNITY WRESTLING CLUB, it’s coaches,
members, committees, volunteers, any and all participants, as well as all affiliates of Siegel Community
Wrestling Club, lessee and operators of premises used to conduct any SCWC event, practices or
activities from any and all liabilities, claims, demands, cause of action or losses of any kind or nature,
past, present, or future, direct or consequential that my child may hereafter have for PERSONAL
INJURY, PERMANENT, TEMPORARY, TOTAL OR PARTICIAL DISABILITY,
DISFIGUREMENT, PARALYSIS AND ANY OTHER LOSSES OR DAMAGES TO PERSON OR
PROPERTY OR DEATH, arising out of my child’s participation in events, practices or activities, but
not limited to, LOSS 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 Siegel Community Wrestling Club activities and the sport
of wrestling in general has inherent dangers that no amount of care, caution, training, instruction,
supervision, or expertise can eliminate, RELEASER EXPRESSLY AND VOLUNTARILY ASSUMES
ALL RISK OR PERSON INJURY, PERMANENT, TEMPORARY, TOTAL OR PARTIAL
DISABIILITY, DISFIGUREMENT, PARALYSIS AND ANY OTHER LOSSES OR DAMAGES TO
PERSON OR PROPERTY OR DEATH, sustained while participating in attending practice or activity,
including the risk of PASSIVE OR ACTIVE NEGLIGENCE OF THE RELEASEE, or hidden, latent or
obvious defects in the facilities or equipment used.
3. Releaser acknowledges and fully understands that each participant in SCWC event, practices or
activities, 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 participants own
action, inactions or negligence, but also from the actions, inactions or negligence of others
notwithstanding the rules of play 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.

(Participant’s Signature) (Date) (Printed Name)

The undersigned, ____________________ does hereby represent that he/she is in fact the

legal guardian of ________________________________ and acting in such capacity

agrees to the terms and conditions of the above stated waiver and release.

(Signature of legal guardian) (Date) (Relationship)