Bronco Kids Wrestling Club

Inland Empire Wrestling Association (IEWA) Athlete Registration Form

Name of child: ________________________________Age/B-day: _________________ Name of Parent: ________________________________ Phone # __________________ Mailing Address: ___________________City _______________State/Zip___________ Email Address:___________________________________________________________ Shirt Size _____ Short Size ________

Please provide copy of birth certificate (new participants only)

Total Cost: $100.00 per participant. $25.00 registration fee (new participants only) Must have valid USA card. New cards must be purchased online in September from ca-usaw.org for $40 Make checks payable to: BKWC or Bronco Kids Wrestling Club
In exchange for the benefits derived by my childs participation in the Bronco Kids Wrestling Club, I HEREBY AGREE TO INDEMNIFY, HOLD HARMLESS, AND NOT SUE THE COACHES, the INVOLVED SCHOOLS & DISTRICTS, THE Bronco Kids Wrestling Club, or THEIR OFFICERS, REPRESENTATIVES, EMPLOYEES, AGENTS, OR VOLUNTEERS for any liability, claims, or actions for injury or death arising out of or in connection with my childs participation in the Bronco Kids Wrestling Club from whatever cause including the active or passive negligence of the coaches, the involved SCHOOLS & DISTRICTS, BKWC, or their officers, representatives, employees, agents, or volunteers. I understand that the sport program by its very nature, presents circumstances which may place the participant at risk for possible injury, serious injury or even death. My child has my permission to participate in the Bronco Kids Wrestling Club.

I HAVE CAREFULLY READ THIS HOLD HARMLESS CLAUSE AND COVENANT NOT TO SUE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT IT IS A FULL RELEASE OF ALL LIABILITY AND SIGN IT OF MY OWN FREE WILL.

Parent or Guardian (Sign) ______________________ (Print)___________________________ Date__________________ Home phone ________________ Work _________________Cell __________________ Alternate emergency contact:_____________________ cell #______________________ If parent or guardian cannot be immediately connected, may the program officials call a physician to help the above named participant in case of emergency?____Yes_____No Medical insurance co. & policy #:___________________________________________ Please list any allergies____________________________________________________ Note: A physical examination is recommended for all Club / Tournament participants.