ROCK BRIDGE WRESTLING CLUB REGISTRATION FORM

NAME______________________________ AGE _____ BIRTHDATE _____/_____/_____

ADDRESS____________________________ CITY ___________ ZIP ________

SCHOOL ________________________________________ GRADE __________

PARENT(S) NAME(S)_________________________ PHONE #______________

CELL PHONE # ____________________________________________________

SHIRT SIZE (circle one)  (Child) 6-8   10-12   14-16    OR     (Adult)   S  M  L  XL  XXL      

                                                                                                                 other ________

E-MAIL:__________________________________________________________

Parental Consent for use of pictures and/or name and statistics on website (initial one):

______ Yes, I'd like my child on the website        ______ No Thanks, no information on website

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ROCK BRIDGE WRESTLING CLUB - ROCK BRIDGE HIGH SCHOOL RELEASE

WAIVER OF CLAIM AND PROMISE TO INDEMNIFY

In consideration of the inclusion of ________________________________in the ROCK BRIDGE WRESTLING CLUB at Rock Bridge High School, we, the undersigned parent or guardian of this child, do hereby waive any and all claims arising from or out of property damage or injury arising from the program. The parent or guardian of the child hereby certifies that the child has had a physical prior to his enrollment in this program sufficient to ascertain his physical condition and suitability for the program, and that he is fit for strenuous physical exercise.

In consideration of inclusion in the program, the parent or guardian further promise to indemnify the club, coaches, coordinators, helpers, Rock Bridge High School, and Columbia Public School District for any claim, lawsuit or settlement, claims for damages, judgment or attorney's fees.

The parent or guardian also gives permission for the ROCK BRIDGE WRESTLING CLUB and its agents to administer first aid or request medical treatment as necessary to insure the well being of their child.

__________________________________________________    ______________

Parent/Guardian                                                                                       Date