Ashtabula Lizards Sign-up Form
Sign-up fee is 70$ per wrestler.
Size Chart: http://lizardwrestling.com/FIGHT_SHORT_AND_SHIRT_SIZE_SUGGESTION.pdf
You can pay at open mats or paypal http://lizardwrestling.com/payment
Parent/Guardian Name *
Your answer
Phone number
Your answer
Email
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number
Your answer
Child's Name *
Your answer
Child's Birth Date *
MM
/
DD
/
YYYY
Child's Grade *
Address *
Your answer
Insurance Company *
Your answer
Insurance Policy Number *
Your answer
Child's Shirt Size *
Child's Shorts Size *
Additional Comments
Your answer
Recognizing the possibility of physical injury associated with the use of the recreational facility or school and engaging in activity and involvement in the lizards wrestling program, the undersigned hereby assumes any risk and releases, discharges and otherwise indemnifies the lizards wrestling program, its volunteers and agents or participants and their parents/guardians against any claim for injuries received by the registrant and/or minor(s) as a result of participation in the program and activity or use of the recreational facilities or during transport to or from same, which transportation is hereby authorized. *
Required
Lizard Wrestling has my permission to use my or my child’s photograph publicly to promote the wrestling program. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use. *
Required
Additional Child?
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