CATOOSA 15 & UNDER WRESTLING

CHILDS NAME_________________________________________AGE____________

BIRTHDAY___________DIVISION_______GRADE______SCHOOL_______________

PARENTS NAME___________________________PHONE_______________________

ADDRESS_____________________________________________________________

WORK PHONE_____________CELL PHONE____________EMAIL_________________

GENERAL RELEASE AND INDEMNITY

I, the undersigned, am of lawful age and I am the guardian or parent of _______________________,and by these presents for and in consideration of my child being permitted to participate in the Catoosa wrestling program, I hereby release and forever discharge, and for my heirs, executors, administrators, and assigns do hereby release and forever discharge all person involved with the Catoosa wrestling program and all persons associated therewith, from any and all claims, demands, rights and causes of action of what so ever kind and nature arising from and by any reason, all known and unknown, foreseen or unforeseen injuries, bodily or otherwise and the consequences thereof resulting in any way from activities of the wrestling program.

IN WHITNESS WHREOF, I hereby sign this instrument the ______day of___,20___.

MEDICAL AUTHORIZATION, RELEASE AND INDEMNITY

I hereby give permission to the physician or dentist selected by the adult in charge of my son/daughter to hospitalize and/or administer appropriate medical or dental treatment, including without limitation, medicine, anesthesia, injection, transfusion and surgery for my child.

I hereby release such supervising adult, physician and/or dentist from any and all claims, demands and causes of action of whatever kind or nature arising from such treatment, and indemnify and hold harmless such supervising adult, physician and/or dentist from any and all claims, demand and causes of action by any person, including without limitation, my child, his guardian and my spouse, with respect to such treatment.

PARENT OR GUARDIAN SIGNATURE_______________________________________

DATE__________________

ENTRY FEE___________

BIRTH CERTIFICATE______________                DIVISION__________________