2018-2019 JC Brawlers Wrestling Club Registration
Information, Consent and Release
Wrestler's First & Last Name: *
Your answer
Nickname (if preferred)
Your answer
Date of Birth
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Age
Your answer
Address
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Parent/Legal Guardian's Contact Information
First and Last Name
Your answer
Home Phone Number
Your answer
Cell Phone Number
Your answer
Email Address
Your answer
First and Last Name
Your answer
Home Phone Number
Your answer
Cell Phone Number
Your answer
Email Address
Your answer
I/We hereby grant permission to the above listed minor to participate with the JC Brawlers Wrestling Club in the Southern Maryland Junior Wrestling League.
Parent/Legal Guardian's Signature (type name) *
Your answer
Date *
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General Publicity Release
The Undersigned acknowledges and agrees that this publicity release is a general release and applies without exception to all activities that the participant competes in, attends or is otherwise involved with in any manner, directly or indirectly at any time.
Wrestling Medical Information
This is private medical information and will only be shared with emergency responders. This form gives our coaches and administrators instructions with how to proceed if your son/daughter becomes injured or ill and needs emergency treatment during your absence.
Wrestling First, Middle & Last Name (Jr/III) *
Your answer
Date of Birth *
MM
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DD
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List Allergies *
Your answer
List Medical Conditions *
Your answer
List Medications
Your answer
Family Doctor
Your answer
Family Doctor Phone
Your answer
Medical Treatment
Please read the alternative statements, check only one preferred option
Pick one *
Parent/Legal Guardian Signature *
Your answer
Date *
MM
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YYYY
Waiver and Release
We understand that the sport of wrestling, in which our child will participate, is potentially dangerous and that physical injuries may occur requiring emergency medical care and treatment. We assume the risks of injury which may occur in this athletic activity. We agree to hold harmless the SOUTHERN MARYLAND JUNIOR WRESTLING LEAGUE and its affiliated wrestling clubs, the BOARD OF EDUCATION OF CHARLES COUNTY, their members, the Superintendent of Schools, the Principal, all coaches, and any and all other agents and agree to indemnify each of them from any claims, costs,
suits, action judgments and expenses arising from our child’s participation in youth wrestling and any injuries received and expenses related thereto.
Parent/Legal Guardian Signature *
Your answer
Date *
MM
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DD
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YYYY
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