Buffalo Wrestling Registration Form

WRESTLER INFORMATION

Buffalo Wrestling Club competes in tournaments both locally and regionally.  Competing is not mandatory however, please check the box below if your wrestler will likely choose to compete in tournaments that are located outside the local area (more than 2 hour drive from The Villages)

Yes No

PARENT INFORMATION

EMERGENCY CONTACT

In case of emergency and the above emergency contact cannot be reached, I hereby authorize my son/daughter to be treated by a qualified, licensed physician who is available to administer such emergency treatment as the child’s condition requires.  It is my intent by this consent to include the administration of drugs, anesthetics and the application of any medication that circumstances may required on an emergency basis by a qualified person.  I am providing below any medical or physical conditions below that your child has that our coaches and/or a medical professional should be made aware.

Yes

PARENT/GUARDIAN CONSENT

My son/daughter  is insured by the following company listed below and has my permission to participate in the Buffalo Youth Wrestling Program under the supervision of the assigned coaches.  I understand that wresting is a potentially hazardous activity.  I assume all risks associated with the sport including but not limited to injury as a result of contact with other participants during the normal course the practices and/or participation in team and/or individual competition.  I further understand that the assigned coaches will take every precaution to ensure the safety of each participant and accept the responsibility of ensuring that my son/daughter abides by all rules and regulations set forth by the coaches.  I further give consent and do so with the full understanding that the Buffalo Youth Wrestling Program, board members and volunteer staff assumes no financial responsibility for any accident and/or injury to my child, which may occur as a result of his or her participation in this program.  I further release the Buffalo Youth Wrestling Program and their representatives of all liability for injury to the aforementioned participant.

Yes

PHOTO RELEASE

I further grant full permission to the Buffalo Youth Wrestling Program and/or agents authorized by them to use my name, likeness, or voice, and photographs, videotapes, quotations, or any other record of my child while participating in this Program with the full understanding that they will be done so in a manner that does not compromise the safety and/or well being of my child and is to promote the organization as a whole.   This permission is perpetual and worldwide.  By signing this release I do so as the parent or legal guardian of the above participant and I agree to all the terms of this waiver as stated above.

Yes

Price


Payment Options


Mailing Address: 1785 CR 228 Wildwood, FL 34785



Form Notices

Unable to display Facebook posts.
Show error

Error: Error validating application. Application has been deleted.
Type: OAuthException
Code: 190
Please refer to our Error Message Reference.