Girls Wrestling Camp Registration Form

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Saturday, November 6, 2021

Please use this form to register for both the Grades 1 - 6 and Grades 7 - 12 camps.

Instructions

Please fill in all required form fields. The registration form is not complete until you click Submit on the second page of this form. You will be redirected to a confirmation page when complete.

Wrestler Information

Wrestler's First Name *

Wrestler's Last Name *

Date of Birth *

YYYY

Wrestler's Gender *

Address *

City *

State *

Zip Code *

Current Grade *

T-Shirt Size *

Approximate Weight (lb) *

Prior Years of Wrestling Experience *

Parent / Guardian 1 Information

Parent / Guardian 1 First Name *

Parent / Guardian 1 Last Name *

Parent / Guardian 1 Email Address *

Parent / Guardian 1 Phone Number *

Parent / Guardian 2 Information

Parent / Guardian 2 First Name

Parent / Guardian 2 Last Name

Parent / Guardian 2 Email Address

Parent / Guardian 2 Phone Number

Emergency Medical Authorization

In the event reasonable attempts to contact me have been unsuccessful, I hereby give my consent for [1] the administration of treatment deemed necessary by the below-named doctor, or, in the event the designated preferred practitioner is not available, by another licensed physician; and [2] the transfer of the child to any hospital reasonably accessible.

This authorization does not cover major surgery unless the medical options of two other licensed physicians, concur in the necessity for such surgery, are obtained prior to the performance of such surgery.

Physician *

Phone Number *

Facts concerning the child(ren)’s medical history, including allergies, medications being taken and any physical impairment which a physician should be alerted

Full Name of Parent / Guardian Granting Consent *

I hereby give consent for the above medical care provider and local hospital to be called

Date Consent Granted *

YYYY

Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement

Please click the link below to open and read the USA Wrestling Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement. When you fully understand, acknowledge, and accept all terms and conditions therein, please indicate you have done so by signing below.

Link - https://perrymightymites.weebly.com/uploads/5/0/2/7/50279631/usawrestlingwaiver.pdf

Full Name of Parent / Guardian for Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement *

By signing this form, as the parent/guardian of the wrestler(s) named in this registration, I acknowledge reading the USA Wrestling Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement and fully understanding, acknowledging, and accepting all terms and conditions therein.

Date of Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement *

YYYY

COVID-19 Acknowledgement and Pledge

Please click the link below to open and read the Perry Local Schools 'COVID Case Management' information site for the District's current plan for managing COVID-19 cases as they continue to monitor local health within our community. As the feeder program for our Perry Schools grades 7-12 wrestling teams and using the same facilities, the Perry Mighty Mites will abide by the current Perry Local School District COVID-19 policies. When you and your wrestler have thoroughly reviewed the policies and contents within and agree to abide by these policies and contents, please indicate you have done so by signing below.

Link - https://www.perry-lake.org/protected/ArticleView.aspx?iid=6YPYII2&dasi=333Y

Full Name of Parent / Guardian for COVID-19 Acknowledgement and Pledge *

By signing this form, as the parent/guardian of the wrestler(s) named in this registration, I acknowledge reading with my wrestler the Perry Local School District COVID Case Management information and agreeing to abide by all current policies and contents.

Date of COVID-19 Acknowledgement and Pledge *

YYYY

Concussion Acknowledgement

Please click the link below to open and read the Ohio Department of Health Concussion Information Sheet For Parents and Athletes. When you and your wrestler have thoroughly reviewed the policies and contents within and agree to abide by these policies and contents, please indicate you have done so by signing below.

Link - https://perrymightymites.weebly.com/uploads/5/0/2/7/50279631/odh-concussion-information.pdf

Full Name of Parent / Guardian Receiving Concussion Information *

By signing this form, as the parent/guardian of the wrestler(s) named in this registration, I acknowledge receiving and reading with my wrestler the concussion information sheet prepared by the Ohio Department of Health.

Date Concussion Information Received and Read *

YYYY

Lindsay's Law Acknowledgement

Please click the link below to open and read the Ohio Department of Health Sudden Cardiac Arrest and Lindsay's Law Information Sheet For Parents and Athletes. When you and your wrestler have thoroughly reviewed the policies and contents within and agree to abide by these policies and contents, please indicate you have done so by signing below.

Link - https://perrymightymites.weebly.com/uploads/5/0/2/7/50279631/odh-lindsayslaw-information.pdf

Full Name of Parent / Guardian Receiving Lindsay's Law Information *

By signing this form, as the parent/guardian of the wrestler(s) named in this registration, I acknowledge receiving and reading with my wrestler the Sudden Cardiac Arrest and Lindsay's Law information sheet prepared by the Ohio Department of Health.

Date Lindsay's Law Information Received and Read *

YYYY

Complete Form and Questions

This registration form is not complete until you click Submit on the second page of this form. You will be redirected to a confirmation page when complete.

Questions about this registration process? Contact Chris Ciolli at christopher.j.ciolli@uwalumni.com.

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