Rochester's Premier Academy of Wrestling

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2022-2023 Wrestling Season

Liability Waiver & Emergency Contact

Wrestler Name *

Wrestler Date of Birth *

YYYY

Parent or Guardian Name *

Parent Phone Number *

Parent Email *

Emergency Contact Name *

Emergency Contact Phone *

Liability Waiver In consideration of Stoney Creek High School providing sponsorship and/or facilities for this program and / or Stoney Creek High School providing facilities, I hereby release and hold harmless and agree to indemnify Stoney Creek High School and/ or Andres Morales and/ or the Premier Academy of Wrestling club and their employees, agents, and representatives from any and all claims, costs, damages, and liabilities for injuries or property sustained or caused by me or my ward while participating in any program offered by Stoney Creek High School and/or the Premier Academy of Wrestling. I understand that fees do not include accident or personal property insurance. I further understand that I am, or my child or ward is physically capable of participating in the program based upon consultation with my, or my child’s or ward’s personal physician. Further, in the event of an injury, I hereby give permission and consent and authorize emergency first aid and/or hospital care or treatment for myself and/or my child/ward if deemed necessary by qualified emergency or medical personnel or by said employees, agents, or representatives of Stoney Creek High School and/or the Premier Academy of Wrestling, and further agree to assume all expenses for said treatment. *

I agree to release Stoney Creek High School, The PAW, Premier Academy of Wrestling, all coaches from any Liability incurred while my son is a member of the club.

Required

Today's Date *

YYYY

Parent or Guardian's Electronic Signature *

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