2021-2022 JC Brawlers Wrestling Club Registration

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Information, Consent and Release

Email *

Wrestler's First & Last Name: *

Nickname (if preferred)

Date of Birth *

YYYY

Age *

My child will wrestle in the following league(s): *

Southern Maryland Junior Wrestling League (SMJWL) mainly Saturday's

NONE (for younger kids that only want to practice)

Other:

Address *

Parent/Legal Guardian's Contact Information

First and Last Name *

Home Phone Number

Cell Phone Number *

Email Address *

First and Last Name

Home Phone Number

Cell Phone Number

Email Address

Payment Selection

I would like to complete my payment registration today - $70

I would like to complete my payment registration later - $70

Clear selection

I/We hereby grant permission to the above listed minor to participate with the JC Brawlers Wrestling Club in the Southern Maryland Junior Wrestling League (SMJWL).

Parent/Legal Guardian's Signature (type name) *

Date *

YYYY

General Publicity Release

The Undersigned acknowledges and agrees that this publicity release is a general release and applies without exception to all activities that the participant competes in, attends or is otherwise involved with in any manner, directly or indirectly at any time.

Wrestling Medical Information

This is private medical information and will only be shared with emergency responders. This form gives our coaches and administrators instructions with how to proceed if your son/daughter becomes injured or ill and needs emergency treatment during your absence.

Wrestling First, Middle & Last Name (Jr/III) *

Date of Birth *

YYYY

List Allergies *

List Medical Conditions *

List Medications

Family Doctor

Family Doctor Phone

Medical Treatment

Please read the alternative statements, check only one preferred option

Pick one *

If my child needs medical attention, it is my wish that I be contacted BEFORE any medical procedures are taken on my child, unless immediate treatment is necessary to save my child's life or to prevent permanent injury.

If my child requires medical attention, it is my wish that treatment is started while efforts to contact me are being made. So that medical treatment is not delayed, I consent to medical procedures that emergency responders believe are necessary. I accept the responsibility for all cost related to such treatment.

Parent/Legal Guardian Signature *

Date *

YYYY

Waiver and Release

We understand that the sport of wrestling, in which our child will participate, is potentially dangerous and that physical injuries may occur requiring emergency medical care and treatment. We assume the risks of injury which may occur in this athletic activity. We agree to hold harmless the SOUTHERN MARYLAND JUNIOR WRESTLING LEAGUE and its affiliated wrestling clubs, the BOARD OF EDUCATION OF CHARLES COUNTY, their members, the Superintendent of Schools, the Principal, all coaches, and any and all other agents and agree to indemnify each of them from any claims, costs,
suits, action judgments and expenses arising from our child’s participation in youth wrestling and any injuries received and expenses related thereto.

Parent/Legal Guardian Signature *

Date *

YYYY

Submit

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