2018 – 1000 Islands Summer Duals

Permission, Release, Waiver of Liability, and Indemnity Agreement  

 

Wrestler’s Name:________________________________________

 

Address: ______________________________________________

 

                ______________________________________________

 

City: _____________________   State:______      Zip:_________

 

Date of Birth:__________________

 

Home Phone: (______) ______________________

 

Emergency Contact:_______________________________

 

Emergency Phone: (______) ______________________

 

          We give our son permission to attend and participate in the 1000 Islands Summer Duals August 3-5, 2018.
  We understand that his participation in this event involves risks and dangers that could result in bodily injury, disability, paralysis, or death.  We hereby release, waive, discharge, and agree not to sue the Eastern Ontario Wrestling Club and/or its staff for any bodily injury, disability, paralysis, or death incurred as a result of participating in this event.  I verify that my son has medical insurance and that a physician has determined he is able to participate in the 1000 Islands Summer Duals.  I also agree to allow my child to be treated by a certified trainer, emergency medical technician, or a licensed physician while attending (if necessary). 

  

________________________                     ________

Parent / Guardian Signature                              Date