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Westside Wrestling Club Information Waiver
Where: Ridgefield High School
When: Mon & Wed Evenings
Times: 7-9 pm
Dates:
March 20 to June 20th
Cost: $70.00 (if you already have a current USA card) or $100.00, which includes the purchase of
USA card, Checks payable to Gary Tiger.
Coaches include Gary Tiger, Ricardo Lopes, Leo Lopes and Frank Cammisa
Application
for Westside Wrestling Club
Assumption of Risk, Waiver and Release of Liability
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NAME.........................................................................................
DATE OF BIRTH ........................................
STREET..................................................................
CITY............................STATE.......................ZIP........
TELEPHONE............................................................................
2005-2006
USAW CARD #...............................................................
Waiver and Release from Liability
1.
I,________________________the undersigned, on behalf of myself, my heirs, and next of kin, personal representatives, agents,
insurers, successors and assigns (all hereinafter "Releasors") hereby FOREVER RELEASE, DISCHARGE AND COVENANT NOT TO SUE THE
UNITED STATES OF AMERICA WRESTLING ASSOCIATION, INC., its insurers, its affiliate clubs, administrators, agents, directors,
officers, state organizations, members, committees, volunteers, all employees of USA Wrestling, and any and all participants,
officials, referees, coaches, host clubs, sponsoring agencies, sponsors, advertisers, local organizing committees (and if
applicable) owners, lessors, and operators of premises used to conduct any USA Wrestling sanctioned event, meet, practice
or activity (all hereinafter "Releasees") from any and all liabilities, claims, demands, causes of action or losses of any
kind or nature, past, present or future, direct or consequential that I may hereafter have for PERSONAL INJURY, PERMANENT,
TEMPORARY, TOTAL OR PARTIAL DISABILITY, DISFIGUREMENT, PARALYSIS AND ANY OTHER LOSSES OR DAMAGES TO PERSON OR PROPERTY OR
DEATH, arising out of my participation in, attendance at or traveling to and from any USAW wrestling sanctioned event or activity
including, but not limited to, LOSSES CAUSED BY THE PASSIVE OR ACTIVE NEGLIGENCE OF THE RELEASEES, or hidden, latent or obvious
defects in the facilities or equipment used.
2. Releasor understands and acknowledges that USA Wrestling sanctioned activities
and the sport of wrestling in general have inherent dangers that no amount of care, caution, training, instruction, supervision,
or expertise can eliminate. RELEASOR EXPRESSLY AND VOLUNTARILY ASSUMES ALL RISK OF PERSONAL INJURY, PERMANENT, TEMPORARY,
TOTAL OR PARTIAL DISABILITY, DISFIGUREMENT, PARALYSIS AND ANY OTHER LOSSES OR DAMAGES TO PERSON OR PROPERTY OR DEATH, sustained
while participating in, attending, preparing for or traveling to and from any USA Wrestling sanctioned event, meet, practice
or activity, including the risk of PASSIVE OR ACTIVE NEGLIGENCE OF THE RELEASEES, or hidden, latent or obvious defects in
the facilities or equipment used.
3.Releasor acknowledges and fully understands that each participant in any USA Wrestling
sanctioned event, meet, practice or activity, including Releasor, will be engaging in activities that involve risk of serious
injury, including permanent, temporary, total or partial disability, disfigurement, paralysis and other losses to person or
property, including death, and that severe social and economic losses may also result not only from Releasor's own actions,
inactions or negligence, but also from the actions, inactions or negligence of others notwithstanding the rules of play or
the condition of the premises or of any equipment used. Furthermore Releasor acknowledges and fully understands that there
may be other associated risks with such activities which are not known or not reasonably foreseeable at this time.
I ACKNOWLEDGE
THAT I HAVE HAD SUFFICIENT OPPORTUNITY TO REVIEW THE PROVISIONS OF THIS DOCUMENT AND UNDERSTAND ITS PURPOSE, MEANING AND INTENT.
.......................................................................... .................................................................
..............
(Participant's Signature) (Print Name) DATE
The undersigned ______________________ does hereby represent
that he/she is, in fact, the parent or guardian of __________________________ and acting in such capacity agrees to the terms
and conditions of the above stated waiver and release.
.................................................................
.............................................................. ............ ...............................................
(Signature
of Parent or Legal Guardian) (Print Name) DATE
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