Deptford Junior Wrestling 2020-2021 Registration WRESTLER INFORMATION FORM

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Please complete this form in the entirety. Please be sure to also pay the full registration fee via Venmo @Deptford-Wrestling

Email *

Child 1 Name (First & Last) *

Child 1 Birthdate *

YYYY

Child 1 Age *

Child 1 School & Grade as of September 2020 *

Child 2 Name (First & Last)

Child 2 Birthdate

YYYY

Child 2 Age

Child 2 School & Grade as of September 2020

Child 3 Name (First & Last)

Child 3 Birthdate

YYYY

Child 3 Age

Child 3 School & Grade as of September 2020

Mother's Name (First & Last) *

Father's Name (First & Last) *

Mailing Address *

Parent's Email Address *

Home Phone Number

Cell Phone Number *

Is your child (children) on medication? *

Yes - Please describe in next box.

If your child is on medication, please describe.

Does your child (children) have any physical or mental problems? *

Yes - Please describe in next box.

If your child has physical or mental problems, please describe.

Emergency Contact Name (First & Last) *

Emergency Contact Phone Number *

Relationship of Emergency Contact to Child *

IN AN EMERGENCY, AND NONE OF THE CONTACTS INDICATED ABOVE CAN BE REACHED, I AUTHORIZE MY CHILD TO BE TREATED BY THE ATTENDING PHYSICIAN. *

Yes

I HAVE READ AND AGREE TO THE "NO TOLERANCE TO VIOLENCE" POLICY ESTABLISHED BY DEPTFORD JUNIOR WRESTLING AND DEPTFORD TOWNSHIP. *

As we move into the new Season, we are all faced with the growing concern of keeping our children safe from harms’ way. As an organization, we are strongly committed to not only teaching our children the value of team play and unity, but most importantly, keeping our children safe. Our children are our #1 priority. Due to the increase in violence in youth sports around our country, Deptford Junior Wrestling has established, and put in to force, a “NO TOLERENCE TO VIOLENCE” Policy. Acts such as any physical or verbal abuse, taunting, fighting, drinking and\or use of drugs, absolutely will not be tolerated at any activity associated with Deptford Junior Wrestling; HOME OR AWAY. Show respect for your child’s coach. If a problem occurs, speak with them after practice or a game. Parents and guardians are fully responsible for their actions and the actions, safety and welfare of their participating and non-participating child. Any action deemed unfit in the presence of a child will not be tolerated. Please be advised that any violation of this policy will result in you and/or your child being removed from any and all activities with Deptford Junior Wrestling without refunds.By submitting this completed form, you are providing a digital signature on this policy.

YES, I HAVE READ AND AGREE TO THE "NO TOLERANCE TO VIOLENCE" POLICY.

I HAVE READ AND AGREE TO THE "CODE OF CONDUCT" ESTABLISHED BY DEPTFORD JUNIOR WRESTLING AND DEPTFORD TOWNSHIP.

Taken from Deptford Township Ord. 18.01

AN ORDINANCE OF THE TOWNSHIP OF DEPTFORD ESTABISHING A YOUTH SPORTS CODE OF CONDUCT
II. Every sports team shall be required to establish an athletic Code of Conduct incorporating at a

minimum the requirements of this Ordinance

III. The parents and guardians of each child participating in a sports team shall be required by the
sports team to execute an agreement acknowledging receipt of said sports team Code of Conduct and agreeing to
be bound thereby.

IV. Any parent, guest, spectator, coach or official at any youth sports event who initiates a fight,
scuffle, or any type of physical abuse or threats of abuse towards any player, coach, official, parent or spectator
shall be banned from attendance at all youth sports events within the Township of Deptford for a period of 12
months from the date of the incident.

V. Any parent, guest, spectator coach or official at any youth sporting event who enters the field
of play, court, or rink during any youth sporting event for the purpose of physically or verbally abusing or
confronting coaches, players or officials shall be banned from attendance at all youth sports events within the
Township of Deptford for a period of 12 months from the date of the incident.

VI. Any parent, guest, spectator, coach or official at any youth sports event who verbally abuses
officials, players or spectators including the use of obscene or profane language or gestures, racial, ethnic or sexual
slurs may be banned from all youth sports events for a period of up to 12 months from the date of the incident and
shall be subject to such discipline as provided for by the applicable sports team’s Code of Conduct.

VII. Any parent, guest, spectator or official at any youth sports event who throws or causes to be
deposited any object on the field of play, court, or rink during any youth sports event may be banned from
attendance at all youth sports events for a period of 12 months from the date of the incident and shall be subject
to such discipline as provided for by the applicable sports teams Code of Conduct.

CODE OF CONDUCT *

YES, I HAVE READ AND AGREE TO THE "CODE OF CONDUCT".

I HAVE READ AND AGREE TO THE COMMUNICABLE DISEASE RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT.

COMMUNICABLE DISEASE
RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT

In consideration of being allowed to participate in any way in a program, related events and activities, I the undersigned, acknowledge, appreciate and agree that:

I am aware there are risks to me of exposure to directly or indirectly arising out of, contributed to, by or resulting from an outbreak of any and all communicable disease, including but not limited to, the virus “severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)”, which is responsible for Coronavirus Disease (COVID-10) and/or any mutation or variation thereof.

I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS DEPTFORD JUNIOR WRESTLING, it’s officers, officials, agents and/or employees, other participants, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (RELEASEES), from any and all claims, demands, losses ,and liability arising out of or related to any ILLNESS, INJURY, DISABILITY OR DEATH I may suffer, WHETHER ARISING FROM THE NEGLIGENCY OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

FOR PARENTS/GUARDIANS OF PARTICIPANT OF MINOR AGE (UNDER AGE 18 AT TIME OF REGISTRATION)
This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liability incidents to my minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.

COMMUNICABLE DISEASE - RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT. *

YES, I HAVE READ AND AGREE TO THE "COMMUNICABLE DISEASE RELEASE OF LIABILITY".

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