MIKE MAL CLINIC - WICHITA, KS
SATURDAY, OCTOBER 17TH
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CLINIC REGISTRATION FORM - 1 PER ATHLETE

REGISTRATION & PAYMENT REQUIRED TO HOLD YOUR WRESTLER(S) SPOT AT THE CLINIC

THIS CLINIC WILL BE GEARED TOWARDS ATHLETES WITH 2+ YEARS OF WRESTLING EXPERIENCE

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* CURRENT 2020-2021 USA WRESTLING CARD IS REQUIRED

** COVID PRECAUTIONS WILL BE ENFORCED DURING THE DURATION OF THE CLINIC

*** PARENT DROP-OFF/PICK-UP ONLY TO LIMIT EXPOSURE

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CONTACT: DEREK PATTERSON * 316.655.3550 * maizewrestlingks@gmail.com

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Email address *
CLINIC FLYER
WRESTLER'S NAME *
CURRENT WEIGHT *
CURRENT AGE *
SESSION INTEREST - PICK ONE *
COVID WAIVER

Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19


The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people.

Maize Wrestling Club (MWC) has put in place preventative measures to reduce the spread of COVID-19; however, MWC cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending MWC practice/competition events could increase your risk and your child(ren)’s risk of contracting COVID-19.

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By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending MWC events and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at MWC events may result from the actions, omissions, or negligence of myself and others, including, but not limited to, MWC coaches, volunteers, and program participants and their families.

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at MWC events or participation in MWC programming ("Claims"). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless MWC, its coaches, facility owners, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of MWC, its coaches, facility owners, and representatives, whether a COVID-19 infection occurs before, during, or after participation at any MWC event.
I HAVE READ AND AGREE TO THE COVID WAIVER FOR MWC EVENTS *
COVID WAIVER PARENT SIGNATURE (IF UNDER 18) *
CLINIC WAIVER
ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM
FOR THE "MIKE MAL CLINIC" (10.17.2020)

I hereby assume all of the risks of participating in the "MIKE MAL CLINIC", including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained or controlled by them, or because of their possible liability without fault.

I certify that I am physically fit and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this clinic. I acknowledge that this Accident Waiver and Release of Liability Form will be used by the organizers of the "MIKE MAL CLINIC" in which I may participate and that it will govern my actions and responsibilities at said clinic.

In consideration of my application and permitting me to participate in the "MIKE MAL CLINIC", I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:

(A)I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from the "MIKE MAL CLINIC". THE FOLLOWING ENTITIES OR PERSONS: "MIKE MAL CLINIC" organizers, Mike Malinconico, Maize Wrestling Club, and/or their coaches, agents, representatives or volunteers.

(B) I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in the "MIKE MAL CLINIC", whether caused by negligence or otherwise.

I acknowledge the "MIKE MAL CLINIC" may carry with it the potential for death, serious injury, and personal loss. The risks may include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, actions of other people including, but not limited to, participants, volunteers, spectators, coaches, and lack of hydration.

I consent and agree that the "MIKE MAL CLINIC", and/or their coaches, agents, representatives or volunteers may take photographs or digital recordings of me s a participant during this event and use these in any and all media for training or promotional purposes. I further consent that my identity may be revealed therein or by description text or commentary. I waive any rights, claims or interest and I understand that there will be no financial or other remuneration.

The accident waiver, release of liability and image release shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.
I HAVE READ AND AGREE TO THE WAIVER FOR THE "MIKE MAL CLINIC" *
CLINIC WAIVER PARENT SIGNATURE (IF UNDER 18) *
CLINIC FEES & PAYMENT
$65/WRESTLER - 2 SESSIONS

PAYMENT WILL SECURE YOUR WRESTLER(S) SPOT AT THE CLINIC

PAYPAL: MAIZE WRESTLING CLUB (maizewrestlingks@gmail.com)

VENMO: @MAIZEWRESTLINGCLUB (maizewrestlingks@gmail.com)
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