WETHERSFIELD YOUTH WRESTLING
2010-2011 SEASON APPLICATION FOR MEMBERSHIP
WRESTLERS NAME ________________________________________________ WEIGHT___________
DATE OF BIRTH ___________________ AGE ________ GRADE __________________________
EMAIL ADDRESS ____________________________ TELEPHONE _________________________ CELL PHONE____________________
STREET ADDRESS ___________________________________ CITY _________________________
Waiver and Release from Liability
I/We, the parent/guardian of the above named candidate, herby give approval to participate in any and all Wethersfield Youth Wrestling activities, including transportation to and from the activities. I/We know that participation in wrestling may result in serious injury and protective equipment does not prevent all injuries to players, and do hereby waive, release, absolve, indemnify and agree to hold harmless the local Wethersfield Youth Wrestling Club, USA Wrestling, the organizers, sponsors, managers, coaches, participants, and persons transporting the candidate to and from activities for any claim arising out of injury to my/our child whether the results of negligence or for any other cause, except to the extent and in the amount covered by accident and liability insurance. I/We agree to return any uniform and other equipment issued to my child in as good a condition as when received except for normal wear and tear.
I ACKNOWLEDGE THAT I HAVE HAD SUFFICIENT OPPORTUNITY TO REVIEW THE PROVISIONS OF THIS DOCUMENT AND UNDERSTAND ITS PURPOSE, MEANING AND INTENT.
Signature of Applicant _____________________ Printed Name______________________ Date _______
The undersigned does herby represent that he/she is, in fact, the parent or guardian of the applicant and acting in such capacity agrees to the terms and conditions of the above stated waiver and release.
Signature of Parent or Legal Guardian and relationship to Minor
Print Name ________________________________ Date _____________________
Fee $65 per wrestler. Sibling $55. Family cap $150.00 Amount Paid ___________________
(Financial assistance is available if needed. Please contact Rick Garrey for details 529-7313)
Make check payable to "Wethersfield Wrestling Club"
35 Harding Street Wethersfield, CT 06109
If you are interested in helping to coach or assist in running our tournament, please ask one of the coaches for details, or mark off the appropriate box and we will contact you. Thank you.
Interested in coaching ___ Interested in helping organize tournaments or fundraisers ___
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