Old Hickory Wrestling Club

Transcription

1 Old Hickory Wrestling Club Jackson Township was named after Andrew Jackson in 1815 following his victory at the Battle of New Orleans. Heavily outgunned and outnumbered, Jackson and his soldiers managed to repel the British invaders and save the nation from defeat. Jackson was strict and short-tempered, but his willingness to suffer alongside his men made him extremely popular. They nicknamed him Old Hickory because he was tough as old hickory wood on the battlefield. Andrew Jackson was famously known for his tenacity, grit, and refusal to back down from a fight. Therefore, the Jackson Takedown Club honors our 7th President Andrew Jackson by naming our wrestling club: Old Hickory Wrestling Club

2 MISSION: Our mission is to help you become as tough as Andrew Jackson and the best wrestler you can be. We are determined to help you achieve your potential in this sport! WHO: Wrestlers in grades Perfect for wrestlers looking to get ready for Youth and Junior High States or get an edge on their competition. WHEN: Thursday evenings from 6:30 PM-8:00 PM WHERE: Jackson High School Wrestling room Fulton Dr. NW Massillon, Ohio Enter through door 16w. MEMBERSHIP COST: *Wrestlers must have a signed waiver on file in order to participate. $ Includes a club T-Shirt Fees will be collected by the Jackson Takedown Club and used to purchase Club T-shirts and new equipment for the OHWC. WHAT: We will train in folkstyle,freestyle, and Greco-Roman Wrestling. ***TO PARTICIPATE IN FS/GR competition, YOU MUST PURCHASE A USA WRESTLING CARD ONLINE. TO GET YOUR CARD GO TO: CONTACT INFORMATION: Website: polarbearwrestling.com E mail- info@polarbearwrestling.com Mail: JACKSON TAKEDOWN CLUB PO BOX 1037, MASSILLON, OHIO Training Sessions: Month and days of that month April-5,12,19,26 May-3,10,17,24 June-5,6,11,12,13,14 OLD HICKORY WRESTLING CLUB REGISTRATION

3 Wrestler s Full Name: USA Card #: Address: Phone: Age: Date of Birth: Grade: T-shirt size: School District: School Attending: Father s Full Name: Father s Address: Father s Home Phone: Work Phone: Cell Phone: Mother s Full Name: Mother s Address: Mother s Home Phone: Work Phone: Cell Phone: Emergency phone number: Contact person: Do parents / guardians carry hospitalization? YES NO (circle one) THIS CLUB DOES NOT CARRY MEDICAL INSURANCE FOR PARTICIPANTS. THE PARTICIPANT S PARENTS AND/OR LEGAL GUARDIAN ASSUME ALL RESPONSIBILITY FOR SAID INSURANCE. Please return via mail to: JACKSON TAKEDOWN CLUB PO BOX 1037 MASSILLON OHIO, 44648

4 CONSENT TO PARTICIPATE, RELEASE, WAIVER OF LIABILITY AND INDEMNITY AGREEMENT In consideration of your acceptance of the undersigned wrestler into the Old Hickory Wrestling Club, sponsored by the Jackson Takedown Club (hereinafter referred to as Club ), we the undersigned, with the intent to be legally bound, do for ourselves, our heirs, executors, administrators and all others claiming by or through us, or as a result of any claim related to the wrestler s participation in the Club or any of its activities, do hereby state that we the undersigned consent to the participant s participation in the Club or any of its activities, do hereby state that we the undersigned consent to the participant s participation in the Club s activities and that we are aware of all risks, hazards and uncertainties connected with participation in the programs and activities of the Club, and do herby waive, release and discharge the Club, and all of its officers, directors, officials, coaches, employees, volunteers, referees and any other individuals acting for or on behalf of the activities or functions of the Club or those it attends. It is the undersigned s specific intent to release, acquit and forever discharge the Club, all of its officers, directors, officials, coaches, employees, volunteers, referees, and any other individuals acting for or on behalf of the Club, from all claims, demands, actions, causes of action, and for all liability for injury, damage or loss of whatsoever kind, nature or description that may arise or be sustained by the participant or those signing this document, which is due in any way or connected in any way with the player s participation in the Club or any of its functions or activities. It is further our specific intent that this release apply to and that it shall be effective as to any injury, damage or claims arising from any act or omission of the Club or any of the individuals released hereby including any injury, damage or claim arising from any negligent act or negligent omission of such organization or individuals but not from acts or omissions of gross or willful negligence or criminal conduct. The participant and the undersigned hereby assume full responsibility for all risk of bodily injury, death or property damage due to ordinary negligence or other conduct of those parties released hereby or otherwise, as a result of any activities connected in any way with the Club. The undersigned on behalf of the participant and for themselves, and all of their heirs, executors and administrators and all others, do hereby further covenant not to sue the Club or any of the individuals should any such suit or claim be instituted at any time, including any claim, demand or suit by the minor participant either before he reaches the age of majority or thereafter, the undersigned do hereby further agree to indemnify and hold the Club, and all of those individuals released hereby, completely and absolutely harmless from all expenses, demands, claims, judgments, fees, attorneys fees, and costs of whatever description or nature which may arise as the result of any such claims being instituted at any time including all costs, fees and expenses involved in defending or investigating any and all claims, demands or causes of action whatsoever that may hereafter be asserted or brought by the participant or anyone on his or her behalf for the purpose of enforcing any claim for damages on account of any injuries or damages sustained during participation in any of the activities of the Club.

5 Emergency Medical Authorization We, the undersigned, do hereby consent and authorize any duly authorized doctor, emergency medical technician, hospital or other medical facility to treat or attempt to treat the participant for any injuries received by said participant while he participates in any activity of the Club, or while traveling to or from or competing in any Club activity. We further authorize any licensed physician to perform any procedure which he or she deems advisable in attempting to treat or relieve any injuries or any related unhealthy conditions in said participant that may be encountered during any necessary procedure or operation. We further consent to the administration of any anesthesia as deemed advisable by any licensed physician, and do hereby further authorize any x-ray examination medical or surgical diagnosis or treatment, and hospital care to be rendered to the participant in our absence under the general or special supervision and on the advice of a licensed physician, surgeon, anesthesiologist, dentist or other qualified personnel acting under their supervision. We, the undersigned, realize and appreciate that there is a possibility of complication and unforeseen consequence in any medical treatment, and we assume any such risk on behalf of ourselves and the participant as stated herein. We acknowledge that here has been now warranty made as to the results of any such treatment or diagnostic procedure. Each of the undersigned expressly acknowledge and agree that they have read and understood the terms of this form, including the CONSENT TO PARTICIPATE, RELEASE, WAIVER OF LIABILITY AND INDEMNITY AGREEMENT coupled with the EMERGENCY MEDICAL AUTHORIZATION and further state that no oral representations, statements or inducements apart from the foregoing written provisions have been made. WE HAVE READ, UNDERSTOOD AND VOLUNTARILY SIGNED THIS REGISTRATION, RELEASE, AND EMERGENCY MEDICAL AUTHORIZATION. PARENT OR GUARDIAN PARENT OR GUARDIAN PARTICIPANT DATE