FALCONs WRESTLING CLUB

2016 REGISTRATION FORM

NAME OF WRESTLER
ADDRESS
CURRENT SCHOOL ATTENDING
GRADE
AGE

CITY
DATE OF BIRTH

NAME OF PARENT(S)/GUARDIAN(S)
HOME PHONE

CELL PHONE

PARENTS EMAIL
EMERGENCY CONTACT

PHONE

VOLUNTEERING: PLEASE CHECK IF YOU ARE WILLING TO VOLUNTEER IN THESE AREAS

COACHING
RIDES TO TOURNAMENTS
TABLE HELP AT FALCON TOURNAMENTS
CONCESSIONS AT FALCON TOURNAMENTS
REGISTRATION COST: $40.00
(CHECKS PAYABLE TO FALCON WRESTLING)

PLEASE READ AND SIGN WAIVER AND LIABILITY RELEASE FORM ON THE
REVERSE SIDE OF THIS FORM.
SHIRT SIZE:

YS

YM

YL

XL

(PLEASE CIRCLE)

STAFF USE ONLY

PAID (PLEASE CIRCLE)
CASH
CHECK #

STAFF INITIALS

CANYON VIEW FALCONS WRESTLING CLUB

WAIVER AND RELEASE OF LEABILITY
In consideration of being allowed to participate in any way in the Canyon View Falcons Wrestling
Club and related events and activities, the undersigned:
1. Agrees that prior to participating he or she will inspect the facilities and equipment to be used, and if they
believe anything is unsafe, he or she will immediately advise the coach or supervisor of such condition(s)
and refuse to participate; or
Agrees that the parent(s) or legal guardian(s) will instruct the minor participant that prior to participating
he or she should inspect the facilities and equipment to be used, and if the participant believes anything is
unsafe they will immediately advise his or her coach or supervisor of such conditions(s) and refuse to
participate.
2. Acknowledges and fully understands that each participant will be engaging in activities that involve risk of
serious injury, including permanent disability and death, and severe social and economic losses, which
might result not only from their own actions, inactions or negligence but the actions, inactions or
negligence of others, the rules of play, or the conditions of the premises or of any equipment used; further,
that there may be other risks not known to us or not reasonably foreseeable at this time.
3. Assumes all the foregoing risks and accepts personal responsibility for the damages following such injury,
permanent disability or death.
4. Intending to be legally bound, does hereby release, waive, discharge and covenant not to sue Canyon View
Falcons Wrestling Club, Canyon View High School Wrestling, Canyon View High School, Iron County School
District, or its affiliated organizations, their respective administrators, officers, directors, agents, coaches
and other employees or volunteers of the organization, other participants sponsoring agencies, sponsors,
advertisers, and if applicable, owners and leasers of premises used to conduct the event, all of which are
hereinafter referred to as releasees , from any and all liability to each of the undersigned, their next of kin
for any claims, demands, losses, or damages on account of injury, including death or damage to property,
caused or alleged to be caused in whole or in part by the negligence of the release or otherwise in
connection with association or entry in and/or arising out of traveling to , participating in, and returning
from competition of any event.
5. In the event that injury or illness is sustained while competing in this activity, the undersigned hereby
authorizes any emergency first aid, medication, medical treatment or surgery deemed necessary by
licensed medical personnel. I also give my permission for attending medical personnel to execute on the
undersigneds behalf permissions forms or other necessary medical documents and to act in behalf if the
undersigned is not immediately available to do so

Parent Name (print)

Parents Signature

Date