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Wrestling Room Collective Contact Information
This form must be completed by all wrestlers who would like to participate in off season training with Wrestling Room Collective. Registration is currently open to all 3rd-8th grade wrestlers. K-2nd grade wrestlers can fill out this form as we gauge interest for opening another training session. The Wrestling Room Collective is located in Seymour, IL and is open to anyone looking for training this offseason whether through instruction or during open mat hours. Registration is first come, first serve as there is limited space in the room each session. You will be notified if you are successfully registered or on a wait list. If there is an interest to help coach in any capacity at the Wrestling Room Collective you must contact Guy Kirby 217-419-0313 for further information.
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Email *
Wrestlers Name *
Email *
Address *
Phone number
Current Year in School *
Years of experience *
Will you be enrolling another child in WRC (list other names and fill out separate form for each)
Parent or Emergency Contact LAST name
Parent or Emergency Contact First name
Parent or Emergency Contact email address
Parent or Emergency Contact Phone number

MANDATORY WAIVER RELEASE 

By submitting this form you are agreeing to the below waiver:

RELEASE, INDEMNIFICATION AND HOLD HARMLESS AGREEMENT In consideration of participating in the sport of wrestling, and for other good and valuable consideration, I hereby agree to release and discharge from liability arising from negligence the Wrestling Room Collective, LLC, and Kindred Homestead(property owner) and its owners, directors, officers employees, agents, volunteers, participants, and all other persons or entities acting for them (hereinafter collectively referred to as “Releasees”), on behalf of myself and my children, parents, heirs, assigns, personal representative and estate, and also agree as follows: 1. I acknowledge that the sport of wrestling involves known and unanticipated risks which could result in physical or emotional injury, paralysis or permanent disability, death, and property damage. Risks include, but are not limited to broken bones, bruises and other bodily injuries caused by falls or contact with walls, floors or other participants,; infections caused by contact with other wrestlers or mats; medical conditions resulting from physical activity; and damaged clothing or other property. I understand such risks simply cannot be eliminated, despite the use of safety equipment, without jeopardizing the essential qualities of the activity. 2. I expressly accept and assume all of the risks inherent in this activity or that might have been caused by the negligence of the Releasees. My participation in this activity is purely voluntary and I elect to participate despite the risks. In addition, if at any time I believe that event conditions are unsafe or that I am unable to participate due to physical or medical conditions, then I will immediately discontinue participation. 3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Releasees from any and all claims, demands, or causes of action which are in any way connected with my participation in this activity, or my use of their equipment or facilities, arising from negligence. This release does not apply to claims arising from intentional conduct. Should Releasees or anyone acting on their behalf be required to incur attorney’s fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs. 4. I represent that I have adequate insurance to cover any injury or damage I may suffer or cause while participating in this activity, or else I agree to bear the costs of such injury or damage myself. I further represent that I have no medical or physical condition which could interfere with my safety in this activity, or else I am willing to assume – and bear the costs of – all risks that may be created, directly or indirectly, by any such condition. 5. In the event that I file a lawsuit, I agree to do so solely in the state where Releasees’ facility is located, and I further agree that the substantive law of that state shall apply. 6. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect. By signing this document, I agree that if I am hurt or my property is damaged during my participation in this activity, then I may be found by a court of law to have waived my right to maintain a lawsuit against the parties being released on the basis of any claim for negligence. I have had sufficient time to read this entire document and, should I choose to do so, consult with legal counsel prior to signing. Also, I understand that this activity might not be made available to me or that the cost to engage in this activity would be significantly greater if I were to choose not to sign this release, and agree that the opportunity to participate at the stated cost in return for the execution of this release is a reasonable bargain. By registering for this camp I have read and understood this document and I agree to be bound by its terms.

GUARDIAN: TYPE NAME or Participate if over 18

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