C.A.C.T.U.S. Wrestling

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Registration Forms

Wrestlers must have a USA Wrestling card which can be purchased for $36.00 at the club or through usawrestling.org and clicking on membership and then become a member

USA Wrestling card must be purchased and kept up to date, it costs $36.00 and expires at the end of August each year.

Please fill out both forms and mail to 125 Commerce Drive Unit 8 Brookfield, CT 06804

Make all checks out to C.A.C.T.U.S. Wrestling

C.A.C.T.U.S. Wrestling LLC.

WAIVER OF LIABILITY AND HOLD HARMLESS STATEMENT

In consideration of being allowed to participate in this training session, related event and activities, I hereby RELEASE, WAIVE, DISCHARGE, and COVENANT NOT TO SUE  C.A.C.T.U.S. Wrestling LLC. and it’s current staff and/or coaching staff (hereinafter referred to as RELEASEE) from any and all liability, claims, demands, or course of action whatsoever arising out of or related to any loss, damage, or injury, including death that may be sustained by me/my child, or to any property belonging to me/my child WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEE, or otherwise, while participating in this training session while in, on or upon the premises where the training session is being conducted.

To the best of my knowledge, I/my child am/is in good physical condition and I am not aware of any physical infirmity which would place me/my child at risk to participate in any way with the training session’s activities.  I am fully aware of risks and hazards connected with the training session.  I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISK OF LOSS, sustained by me/my child, or any loss or damage to property owned by me/my child, as a result of being engaged in the training session’s activities, WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEE, or otherwise.  I further hereby AGREE TO INDEMNIFY AND HOLD HARMLESS the RELEASEE from any loss, liability, damage or cost, including court costs and attorney’s fees, that may accrue related to me/my child’s participation in this training session, WHETHER CAUSE BY NEGLIGENCE OF RELEASEE or otherwise.

During the period of the training session, I hereby give permission for the staff at C.A.C.T.U.S. Wrestling LLC to administer appropriate medical attention to me/my child in the event of an accident, illness, or injury.  I will be responsible for any and all costs of medical coverage and treatment provided not covered by insurance.  It is my express intent that this Waiver of Liability and Hold Harmless Agreement shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representative, if I an deceased, and shall be deemed as a RELEASE, WAIVER, DISCHARGE, AND COVENANT NOT TO SUE the above named RELEASEE.  I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be construed in accordance with the law of the State of Connecticut.  In signing this release, I acknowledge and represent that I have read and understand it and sign it voluntarily; I am at least eighteen (18) years of age and fully competent; and I execute this Release for full, adequate and complete consideration fully intending to be bound by same.

I HAVE READ AND UNDERSTAND THIS WAIVER OF LIABILITY AND FULLY UNDERSTAND IT’S TERMS, UNDERSTAND THAT I HAVE FIVEN UP SUBSTANTIAL RIGHT BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT AND INDUCEMENT.

                                                                                                                                                                                                                               

Participant’s  Name                                                                 E-Mail Address

                                                                                                                                                                                                                                                Parent’s Printed Name                                                             Parent’s Signature                                                                   Date

                                                                                                                                                                                                                                                Address                                                                                      City                                                        State                                Zip

INSURANCE INFORMATION

Please indicate the insurance company and policy number under which your child is insured.

Person Carrying Insurance:                                                                                                                                                                                                     

Company:                                                                                                                                                                                                                               

Policy Number:                                                                                                                                                                                                                       

PLEASE NOTE ANY MEDICAL CONDITION WE SHOULD BE AWARE OF: 

                                                                                                                                                                                                                                               

Current Medications:                                                                                                                                                                                                              

Date of last tetanus shot:                                                                                                                                                                                                         

Emergency Contact:                                                                                                                                                                                                                                

                                                Name                                                       Relationship                                                             Phone

Emergency Contact:                                                                                                                                                                                                                                

                                                Name                                                       Relationship                                                             Phone

T-Shirt Size Adult- S M L XL

                      Youth S M L XL

WRESTLING 2012-2013 SEASON APPLICATION FOR MEMBERSHIP

No Out of State Checks accepted by USAWCT

_______________________________                  ______________________________________

Club                                                                        Card Number

DATE OF BIRTH______________________________ AGE _________________ GRADE _______________

NAME______________________________________________________TELEPHONE____________________

ADDRESS______________________________________________________________________________

City, State & Zip code_____________________________________________________________

Email Address _______________________________________________________________________

Waiver and Release from Liability

1. I, ________________________ the undersigned, on behalf of myself, my heirs, and next of kin, personal representatives, agents, insurers, successors and assigns (all hereinafter "Releasors") hereby FOREVER RELEASE, DISCHARGE AND COVENANT NOT TO SUE THE UNITED STATES OF AMERICA WRESTLING ASSOCIATION, INC., its insurers, its affiliate 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 if applicable) owners, lessors, and operators of premises used to conduct any USA Wrestling sanctioned 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 USA Wrestling sanctioned 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 USA Wrestling sanctioned 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 USA Wrestling sanctioned 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 USA Wrestling sanctioned 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 other losses to person or property, including death, and that severe social and economic losses may also result not only from Releasor's own actions, 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. Furthermore 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.

I ACKNOWLEDGE THAT I HAVE HAD SUFFICIENT OPPORTUNITY TO REVIEW THE PROVISIONS OF THIS

DOCUMENT AND UNDERSTAND ITS PURPOSE, MEANING AND INTENT.

_________________________           _________________________         _________________

 (Signature of Wrestler)                               (Print Name)                                    (Date)

The undersigned ______________________ does hereby represent that he/she is, in fact, the parent or

guardian of  _________________________ and acting in such capacity agrees to the terms and conditions

of the above stated waiver and release.

________________________________________________________________

(Signature of Parent or Legal Guardian and Relationship to Minor)

__________________________                         ___________________

  (Print Name)                                                         (Date)