RAM YOUTH WRESTLING CLUB
REGISTRATION AND MEDICAL CONSENT FORM
The following is to certify that the above named child has my/our permission to participate in the Ram Wrestling Club Program. I/We hereby release the Ram Wrestling Club and its management, coaches and sponsors from any and all responsibility, liability, or claims for damages which I/We or my child may receive by participating in the above named program or while traveling to or from the event where the program is being conducted. I/We also do hereby give permission for the Ram Wrestling Club to seek emergency medical attention in the event of injury during practice or any wrestling event if a parent or legal guardian is not available. The Ram Wrestling Club will make every reasonable effort to contact you or your emergency contact designee before any action is taken.
Signatures of Parent or Legal Guardian: ________________________________________________ Dated: ___________ Phone #: ___________________ ________________________________________________ Dated: ___________ Phone #: ___________________
Emergency Contact: ______________________________________________ Phone #: ____________________________ *Note: Please notify and provide your emergency contact with your child's medical history including medical insurance plan and numbers. Special Needs/Allergies/Skin Conditions: ________________________________________________________________ ________________________________________________________________ Insurance Company: _____________________________________________ Policy #: _____________________ ID #: __________________________ Name of Insured: __________________________________________ Doctor’s Name & Phone #: __________________________________ 07/09