Girls Wrestling Camp Registration Form
Saturday, November 6, 2021

Please use this form to register for both the Grades 1 - 6 and Grades 7 - 12 camps.
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Instructions
Please fill in all required form fields. The registration form is not complete until you click Submit on the second page of this form. You will be redirected to a confirmation page when complete.
Wrestler Information
Wrestler's First Name *
Wrestler's Last Name *
Date of Birth *
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Wrestler's Gender *
Address *
City *
State *
Zip Code *
Current Grade *
T-Shirt Size *
Approximate Weight (lb) *
Prior Years of Wrestling Experience *
Parent / Guardian 1 Information
Parent / Guardian 1 First Name *
Parent / Guardian 1 Last Name *
Parent / Guardian 1 Email Address *
Parent / Guardian 1 Phone Number *
Parent / Guardian 2 Information
Parent / Guardian 2 First Name
Parent / Guardian 2 Last Name
Parent / Guardian 2 Email Address
Parent / Guardian 2 Phone Number
Emergency Medical Authorization
In the event reasonable attempts to contact me have been unsuccessful, I hereby give my consent for [1] the administration of treatment deemed necessary by the below-named doctor, or, in the event the designated preferred practitioner is not available, by another licensed physician; and [2] the transfer of the child to any hospital reasonably accessible.

This authorization does not cover major surgery unless the medical options of two other licensed physicians, concur in the necessity for such surgery, are obtained prior to the performance of such surgery.
Physician *
Phone Number *
Facts concerning the child(ren)’s medical history, including allergies, medications being taken and any physical impairment which a physician should be alerted
Full Name of Parent / Guardian Granting Consent *
I hereby give consent for the above medical care provider and local hospital to be called
Date Consent Granted *
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Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement
Please click the link below to open and read the USA Wrestling Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement. When you fully understand, acknowledge, and accept all terms and conditions therein, please indicate you have done so by signing below.

Link - https://perrymightymites.weebly.com/uploads/5/0/2/7/50279631/usawrestlingwaiver.pdf
Full Name of Parent / Guardian for Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement *
By signing this form, as the parent/guardian of the wrestler(s) named in this registration, I acknowledge reading the USA Wrestling Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement and fully understanding, acknowledging, and accepting all terms and conditions therein.
Date of Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement *
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COVID-19 Acknowledgement and Pledge
Please click the link below to open and read the Perry Local Schools 'COVID Case Management' information site for the District's current plan for managing COVID-19 cases as they continue to monitor local health within our community. As the feeder program for our Perry Schools grades 7-12 wrestling teams and using the same facilities, the Perry Mighty Mites will abide by the current Perry Local School District COVID-19 policies. When you and your wrestler have thoroughly reviewed the policies and contents within and agree to abide by these policies and contents, please indicate you have done so by signing below.

Link - https://www.perry-lake.org/protected/ArticleView.aspx?iid=6YPYII2&dasi=333Y
Full Name of Parent / Guardian for COVID-19 Acknowledgement and Pledge *
By signing this form, as the parent/guardian of the wrestler(s) named in this registration, I acknowledge reading with my wrestler the Perry Local School District COVID Case Management information and agreeing to abide by all current policies and contents.
Date of COVID-19 Acknowledgement and Pledge *
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DD
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Concussion Acknowledgement
Please click the link below to open and read the Ohio Department of Health Concussion Information Sheet For Parents and Athletes. When you and your wrestler have thoroughly reviewed the policies and contents within and agree to abide by these policies and contents, please indicate you have done so by signing below.

Link - https://perrymightymites.weebly.com/uploads/5/0/2/7/50279631/odh-concussion-information.pdf
Full Name of Parent / Guardian Receiving Concussion Information *
By signing this form, as the parent/guardian of the wrestler(s) named in this registration, I acknowledge receiving and reading with my wrestler the concussion information sheet prepared by the Ohio Department of Health.
Date Concussion Information Received and Read *
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DD
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Lindsay's Law Acknowledgement
Please click the link below to open and read the Ohio Department of Health Sudden Cardiac Arrest and Lindsay's Law Information Sheet For Parents and Athletes. When you and your wrestler have thoroughly reviewed the policies and contents within and agree to abide by these policies and contents, please indicate you have done so by signing below.

Link - https://perrymightymites.weebly.com/uploads/5/0/2/7/50279631/odh-lindsayslaw-information.pdf
Full Name of Parent / Guardian Receiving Lindsay's Law Information *
By signing this form, as the parent/guardian of the wrestler(s) named in this registration, I acknowledge receiving and reading with my wrestler the Sudden Cardiac Arrest and Lindsay's Law information sheet prepared by the Ohio Department of Health.
Date Lindsay's Law Information Received and Read *
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Complete Form and Questions
This registration form is not complete until you click Submit on the second page of this form. You will be redirected to a confirmation page when complete.

Questions about this registration process? Contact Chris Ciolli at christopher.j.ciolli@uwalumni.com.
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