Chatfield Junior Wrestling

Registration '08-'09

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Permission/Waiver/Consent:

All athletics carry a risk for injury and or permanent disability including the possibility of death.  Such injuries are not common, but the risk  exists.  Athletes and parents can reduce this risk by complying with club rules and coach’s instructions.  ATHLETES AGREE TO OBEY ALL SAFETY AND TRAINING RULES,  WEAR RECOMMENDED SAFETY EQUIPMENT, FOLLOW INSTRUCTIONS OF COACHES, PROMPTLY REPORT ANY PHYSICAL OR INTERPERSONAL PROBLEMS TO THEIR COACHES AND FOLLOW  CONDITIONING AND NUTRITION/FLUID INTAKE RECOMMENDATIONS.

 CHATFIELD JR WRESTLING AND  WESTERN SUBURBAN YOUTH WRESTLING DO NOT ENCOURAGE OR CONDONE THE LOSS OF WEIGHT OF ANY ATHLETE FOR THE PURPOSE OF COMPETITION.  ANY WEIGHT LOSS SHOULD ONLY BE BASED ON THE RECOMMENDATION AND UNDER THE DIRECTION OF A PHYSICIAN.

 I/we the parents of the below named wrestler hereby give permission for this child to participate in Chatfield Junior Wrestling and associated activities.  I/we assume all risks and hazards of such activity, and  hereby agree to release and hold harmless the Chatfield Junior Wrestling club and coaches, Western Suburban Youth Wrestling, Chatfield High School, Jefferson County Public Schools and any parties associated with them except for  cases of gross negligence for any cases arising from injury, disability or death of participant.  I/we also understand that Chatfield Junior Wrestling does not carry primary liability or accident insurance for participants or coaches, and confirm that responsibility for medical care/insurance for the below named child shall be the sole responsibility of  their parent(s)  I/we also agree that in our absence, or if we are unable to be reached, the coach/parent presiding over an event or practice may make emergency medical decisions for our child.  I/we agree to be financially responsible for any such decisions, and not hold such person(and affiliates as above) responsible for any decisions or lack of decisions.

 Parent Signature (typed name in the appropriate box below indicates signature and agreement with above)

Fee: $100         hitting the "submit" button will take you to the payment page.  Be sure all info is correct prior to submitting form.  (clicking "submit" does indicate that you are submissive!)

You should receive a confirmation e-mail within 24 hours.  Please call or e-mail if you don't receive confirmation after 24hrs.

Wrestlers Name
Age as of Sept. 1, 2008
Home phone
Fathers name
Best Phone Father
Mothers name
Best Phone Mother
Mailing address
City
Zip Code
Wrestlers Date of birth
Years of Experience
Approx. weight
E mail
School
Grade
Emergency contact
Emergency phone
Doctors name
Doctor phone
Date of last physical
Medical conditions
Allergies
Medications