Autorization of Legal Representation

							                  2009 – 2010 CYW Registration Form
                                            WRESTLER’S INFORMATION
Wrestler #1 Name:                                                                                   DOB:

                                                                                                    Grade:
Wrestler #2 Name:                                                                                   DOB:

                                                                                                    Grade:
Address:                                                                                            Approx. Weight:


Parent or Guardian:                                                                                 Years Experience:


Contact Numbers
     Home Phone:
     Cell Phone(s):
Medical /Emergency Contact information
Emergency Contact:
Phone:
Relationship to wrestler:
Insurance carrier:
Policy #:
                    E-Mail: VERY IMPORTANT: Primary route for communication
Primary:                                                           Secondary:

                                                       Program (check one)
              K-2 ($95.00) __________                                    G3-8 ($110.00) __________

Tuesdays 5:30-7:00, beginning December 1                           month of November: Tues & Fri 6-8 pm beginning
at the Central Baptist Church                                      Nov. 3 at Central Baptist Church
                                                                   starting December 1: Tues & Thurs 6- 8 pm at
                                                                   Parker School Gym
Apparel for CYW will go exclusively through our web site and the EmbroidMe store. The required apparel is as
follows;

K-3 CYW Tee Shirt ($15) & Shorts ($15)
3-8 CYW Tee Shirt ($15) & Shorts ($15)
3-8 (Travel) CYW Tee Shirt ($15), Shorts ($15), Hoody ($30) and PJ Pants ($21)

*Travel team is any wrestler planning to participate in Tourneys and Dual Meets.
*If you already own some of the uniform, that is in good condition, you do not need to re buy those items.
*Tee shirt is new this year and will need to be purchased.
*Plain Black shorts can be used in place of CYW shorts.

                                                     Parental Consent
WAIVER AND PHOTOGRAPH AUTHORIZATION
Chelmsford Youth Wrestling
CONSENT AND RELEASE FORM
I/We, the undersigned , being the parent(s) or guardian(s) of the Particiapan, who is my/our child or ward, a minor, do hereby
consent to my/our child’s or ward’s (the “child” or the “child’s”) participation in voluntary athletic, recreation or extra-curricular
programs (the “Programs”) provided by Chelmsford Youth Wrestling.

I/We represent and warrant that I/we am or are the parent(s) or guardian(s) of the child with authority to so consent and to sign this
Consent and Release Form (the “Form”).

I/We understand that participation in the Chelmsford Youth Wrestling Program carries the possibility of physical injury and may
involve physical activity that may be strenuous and that there are risks inherent in the the sport of wrestling.

I/We agree to forever release the Chelmsford Youth Wrestling, all of its officers, members, officers, directors, employees, agents,
board members, volunteers, coaches, assistants, administrators or other associates of Chelmsford Youth Wrestling (the
“Releasees”), assisting, participating or providing services in the Programs of the Releasees from any and all claims, rights of
action and causes of action that may have arisen in the past, or may arise in the future, directly or indirectly, from personal injuries
to the child or property damage resulting from the child’s participation in the Programs.

I/We also agree to indemnify, defend, and hold harmless the Releasees against any and all legal claims and proceedings of all
description that may have been asserted or may be asserted in the future, directly or indirectly, arising from personal injuries to the
child or property damage resulting from the child’s participation in the Programs.

I/We understand that the child’s participation in the Programs is voluntary and that the child and I/we am or are free to choose not
to participate in the Programs. By signing this Form, I/we affirm that I/we have decided to allow the child to participate in the
Programs with full knowledge that the Releasees will not be liable to anyone for personal injuries and property damage the child or
I/we may suffer as a result of participating in the Programs.I/We further affirm that I/we have read this Form with care and that I/we
understand the contents of this Form.

I/We understand and acknowledge that this Form is a legal instrument, which may affect my/our legal or the child’s legal rights,
and that I/we was or were afforded the opportunity to have this Form reviewed by legal counsel of my/our choice before my/our
signing this Form.

I/We sign this Form voluntarily and freely without duress.

I/We further acknowledge that the Releasees have made no representation of fact or opinion to me/us, which in any manner had
induced me/us to agree to sign this Form.

PHOTOGRAPH AUTORIZATION. I/We, do hereby acknowledge that Chelmsford Youth Wrestling photographs participants and
publishes such photographs for promotional use, display or for posting on its or its progams’ websites. I/We, the undersigned,
hereby consent to the photographing of my/our child or ward and publishing of such photographs for the purposes stated herein or
for purposes related to the program in which my/our child is participating.
Signature of Parent or Guardian:                                                             Date:


                                                 Registrar Use Only:
Amount:                                                 Registrar Initials:
Check No. _____             OR         Cash_____        Date: