REGISTRATION – Shelton Wrestling

USA WRESTLING CARD NUMBER(Required)

You will need to purchase either the limited or full membership BEFORE REGISTERING.

PARENT/LEGAL GUARDIAN #1(Required)

PARENT/LEGAL GUARDIAN #1 PHONE(Required)

PARENT/LEGAL GUARDIAN #2

PARENT/LEGAL GUARDIAN #2 PHONE

EMERGENCY CONTACT PHONE NUMBER(Required)

EMERGENCY CONTACT PHONE NUMBER

PLEASE EXPLAIN YOUR CHILDS MEDICAL, ALLERGIC, OR BEHAVIORAL ISSUES?(Required)

PHYSICIAN'S OFFICE NUMBER

YOUR INSURANCE COMPANY

HOW MUCH CAN YOU AFFORD NOW ?

REGISTRATION - PAYMENT UNDERSTANDING

Parent / Legal Guardian Signature(Required)

I UNDERSTAND THAT MY REGISTRATION IS NOT COMPLETE UNTIL THE REGISTRATION FEE HAS BEEN PAID IN FULL AND A COPY OF MY ATHLETES BIRTH CERTIFICATE HAS BEEN RECEIVED.

CONSENT TO MEDICAL CARE AND TREATMENT

ALL CHILDREN REGISTERED WITH THE SHELTON WRESTLING CLUB WILL BE INSURED BY A SECONDARY CARRIER PROVIDED BY USAWRESTLING, EFFECTIVE AFTER PARENT/GUARDIAN INSURANCE HAS BEEN EXHAUSTED. THERE IS A DEDUCTIBLE ON THE USAW INSURANCE. SHELTON WRESTLING CLUB RECOMMENDS A PHYSICAL EXAMINATION FOR YOUR CHILD PRIOR TO PARTICIPATION.

Parent / Legal Guardian Signature(Required)

I, (PARENT/GUARDIAN NAME LISTED ABOVE) AUTHORIZE ALL MEDICAL AND SURGICAL TREATMENT, X-RAY, LABORATORY, ANESTHESIA AND OTHER MEDICAL HOSPITAL PROCEDURES AS MAY BE PERFORMED OR PRESCRIBED BY A LICENSED PHYSICIAN AND FACILITIES FOR (CHILD’S NAME LISTED ABOVE). IT IS EXPECTED 1 PARENT/GUARDIAN STAYS AT PRACTICE. IF PARENT IS NOT AVAILABLE YOU AUTHORIZE FOR MEDICAL RELEASE.

HOLD HARMLESS AGREEMENT

WRESTLING IS A VIGOROUS ACTIVITY AND THE POSSIBILITY OF INJURY DOES EXIST.

Parent / Legal Guardian Signature(Required)

I GIVE APPROVAL AND PERMISSION FOR MY CHILD TO PARTICIPATE IN THE SHELTON WRESTLING ASSOCIATION. I HEREBY WAIVE ALL CLAIMS AND LEGAL ACTION, FINANCIAL OR OTHERWISE, AGAINST THE ABOVE JUNIOR WRESTLING CLUB, IT’S ELECTED AND APPOINTED OFFICIALS, OR ANY VOLUNTEER CONNECTED WITH THE PROGRAM FOR INJURIES WHICH MIGHT OCCUR DURING PRACTICE, TRAVEL OR GAME COMPETITION.

Registration and Release (Online)

REGISTRATION - PAYMENT UNDERSTANDING

CONSENT TO MEDICAL CARE AND TREATMENT

HOLD HARMLESS AGREEMENT

PAYMENT / FINANCIAL SECTION