Registration and Liability Waiver: 3F Wrestling High School Program
Email address *
Wrestler's First Name: *
Wrestler's Last Name: *
Wrestler's Date of Birth *
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Weight (in pounds): *
Grade (9th, 10th, etc.): *
School (e.g., Vandegrift HS, Lake Travis HS, etc.): *
Wrestler's # of years previous wrestling experience: *
Wrestler has a valid USAW Athlete membership for the current membership year (Sept 2019-Aug 2020). *
Wrestler's USAW Membership Number: *
3F Wrestling is listed as a Club Affiliation on Wrestler's USAW Profile:
Clear selection
#1 Parent/Guardian Name: *
#1 Parent/Guardian Relationship (mother, father, etc.) *
#1 Parent/Guardian -- Complete Home Address *
#1 Parent/Guardian -- Email: *
#1 Parent/Guardian -- Cell Phone: *
#1 Parent/Guardian -- Additional Phone:
#2 Parent/Guardian Name:
#2 Parent/Guardian Relationship (mother, father, etc.)
#2 Parent/Guardian -- Complete Home Address (if different from #1 parent/guardian above)
#2 Parent/Guardian -- Email:
#2 Parent/Guardian -- Cell Phone:
#2 Parent/Guardian -- Additional Phone:
Please indicate another person to call in an urgent situation if we are unable to reach parents/guardians above (name and phone number): *
Wrestler's Drug Sensitivities or Other Allergies?
Liability Waiver (please read -- then agree by printing your name at the bottom )
Wrestling: Waiver and Release from Liability

1. I, the wrestler’s parent or legal guardian, on behalf of myself, my heirs and next of kin, personal representative, agents, insurers, successors and assigns (all hereinafter "Releasors") hereby forever release, discharge and covenant not to sue Four Points Viper Wrestling or any successor or predecessor business entity or wrestling club, 3F Wrestling or any successor or predecessor business entity or wrestling club, Matthew Gochberg DBA Four Points Viper Wrestling, Martin Strmiska DBA 3F Wrestling, Matthew Gochberg, Martin Strmiska, Leander ISD, or TX-USA Wrestling, nor their insurers, their affiliated or controlled legal entities or clubs, administrators, agents, directors, officers, state organizations, members, committees, volunteers, all employees of USA Wrestling, and any and all participants, officials, referees, coaches, host clubs, sponsoring agencies, sponsors, advertisers, local organizing committees and owners, lessors and operators of premises used to conduct any wrestling event, meet, practice or activity (all hereinafter "Releasees") from any and all liabilities, claims, demands, causes of action or losses of any kind or nature, past, present or future, direct or consequential that I may hereafter have for PERSONAL INJURY, PERMANENT, TEMPORARY, TOTAL OR PARTIAL DISABILITY, DISFIGUREMENT, PARALYSIS AND ANY OTHER LOSSES OR DAMAGES TO PERSON OR PROPERTY OR DEATH, arising out of my participation in, attendance at or traveling to and from any wrestling event or activity including, but not limited to, LOSSES CAUSED BY THE PASSIVE OR ACTIVE NEGLIGENCE OF THE RELEASEES, or hidden, latent or obvious defects in the facilities or equipment used.

2. Releasor understands and acknowledges that wrestling activities and the sport of wrestling in general have inherent dangers that no amount of care, caution, training, instruction, supervision or expertise can eliminate. RELEASOR EXPRESSLY AND VOLUNTARILY ASSUMES ALL RISK OF PERSONAL INJURY, PERMANENT, TEMPORARY, TOTAL OR PARTIAL DISABILITY, DISFIGUREMENT, PARALYSIS AND ANY OTHER LOSSES OR DAMAGES TO PERSON OR PROPERTY OR DEATH, sustained while participating in, attending, preparing for or traveling to and from any wrestling event, meet, practice or activity, including the risk of PASSIVE OR ACTIVE NEGLIGENCE OF THE RELEASEES, or hidden, latent or obvious defects in the facilities or equipment used.

3. Releasor acknowledges and fully understands that each participant in any wrestling event, meet, practice or activity, including Releasor, will be engaging in activities that involve risk of serious injury, including permanent, temporary, total or partial disability, disfigurement, paralysis and any other losses to person or property, including death, and that severe social and economic losses may result not only from releasor's own action, inactions or negligence, but also from the actions, inactions or negligence of others notwithstanding the rules of play or the condition of the premises or of any equipment used. Further Releasor acknowledges and fully understands that there may be other associated risks with such activities which are not known or not reasonably foreseeable at this time.

4. For the avoidance of doubt, Releasor acknowledges and fully understands that this release, discharge and covenant not to sue explicitly includes, but is not limited to, all losses and damages of any kind arising out of Releasor’s presence, or the presence of those accompanying Releasor, on the property of Matthew Gochberg, Martin Strmiska, or Leander ISD, or on the property of any entity affiliated with, leased by, or otherwise controlled by Matthew Gochberg, Martin Strmiska, or Leander ISD even when such losses or damages are not directly related to the dangers inherent in wrestling.


I ACKNOWLEDGE THAT I HAVE HAD SUFFICIENT OPPORTUNITY TO REVIEW THE PROVISIONS OF THIS DOCUMENT AND UNDERSTAND ITS PURPOSE, MEANING AND INTENT.

Electronic Signature: By printing my name below, I represent that I am, in fact, the wrestler’s parent or legal guardian, and acting in such capacity have read the above Liability Waiver and agree to its terms and conditions. *
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