Wrestler Name *

First Name

Last Name

Guardian 1 Name *

First Name

Last Name

Guardian 1 Phone *

(###)

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Guardian 2 Name

First Name

Last Name

Guardian 2 Phone

(###)

###

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Waiver *

As the parent or legal guardian of the above, by checking the box I hereby waive, release, indemnify and hold harmless the Falcon Youth Wrestling Club, its officers, directors, administrators, instructors, coaches, agents, representatives, and/or assigns, or the like who are associated with the program in any way, from any injury or lability whatsoever which may result from the child’s participation in the program. Further, I hereby affirm that the child is medically able to participate in the program, without limitation.

Yes, agree to the waiver.