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FIREBIRD WRESTLING CLUB

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					                                         FIREBIRD WRESTLING CLUB

                                       HOLD HARMLESS AGREEMENT

I, we, the undersigned participant/parent, on behalf of myself, my heirs, legatees, and assigns, hereby agree to
indemnify, save and hold harmless the Firebird Youth Wrestling Club, St. Peter Chanel High School, the Bishop and
Diocese of Cleveland or any of their coaches, agents, representatives, employees, or assigns, for my health, safety or
any injury and/or disability arising out of or result from: Wrestling

As a participate/parent in the program, I/we recognize and acknowledge that there are certain risks of physical injury
and I/we agree to assume full risk of any injuries, including loss of life, damages or loss which I/we may sustain as a
result of participating in any and all activities connected with or associated
with the program.

I have prepared myself for the sport in which I am participating adequately conditioning myself and practicing, I/we
hereby represent that I have no physical restrictions which would prohibit my participation in the sport that I have
selected. The Firebird Youth Wrestling Program has my permission to have a physician attend to me if deemed
necessary unless instructed otherwise in writing by my parent/legal guardian during my participation in this
wrestling program.

I/we further agree to waive and relinquish all claims, fully release and discharge and agree to indemnify and hold
harmless and defend the Firebird Youth Wrestling Club and St. Peter Chanel High School and it officers, agents
servants and employees from any and all claims resulting from injuries, including loss of life, damages and losses
sustained by me and arising out of, connected with, or in any way associated with activities of the program.

It is mutually understood that the Firebird Wrestling Club is not officially affiliated in any fashion with St. Peter
Chanel High School and simply uses the school’s facilities for it activities. Any member of the St. Peter Chanel
Staff associated with Firebird Youth Wrestling Club does so by separate agreement with that organization and is not
acting as an agent of St. Peter Chanel High School. Permission is also granted to use my name and/or photograph
for any publication deemed suitable by the Clum in a positive nature. This would include, but is not limited to
photos displayed, athletic programs, club website, or use by the media.

Parent or Guardian Signature_______________________________________________________________

Child’s Name (Printed) ___________________________________________________________________

Date __________________________

                                    TEAM ROSTER INFORMATION

Wrestler’s Name________________________________________________________________________

Parent’s Name_________________________________        _________________________________
                          Mom                                  Dad
Street Address_________________________________________________________________________

City, Zip_________________________________________ Home Phone _________________________

Pager/Cell Phone _______________________________________________________________________

Email Address _________________________________________________________________________

Birthday_______________________________Age____________________Grade___________________

*DUES ARE NON-REFUNDABLE *                          PLEASE SUBMIT TO TODD ASSAD OR DAN KAMINSKI

				
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