Tear this off and Mail with check
Payable to I-44 Wrestling
C/O Brent Batcheller-RSHS
1780 Hawkins Rd
Fenton MO 63026

Name:___________________
Grade:________ Age:______
Address:_____________________
            ______________________
Parent Contact:__________________
Phone: Home/Work:________________
Cell:_____________________________
Waiver of Liability:
In consideration of the Rockwood School District permitting me to use their facilities, practice, play, or in any other way participate in activites related to the I-44 Wrestling Club including practicing, conditioning, playing and traveling, I hereby voluntarily assume all of the risks and hazards associated with such participation. I agree to waive all claims of whatever nature, fully and finally, now and forever, for myself, my estate, my heirs, my administrators, my executors, my assignees, my successors, and for all members of my family. I also agree to release, exonerate, discharge and hold harmless the above named wrestling club, school district, school, their trustees, officers, agents, servants, employees, successors and assignees, including their athletic staffs, coaches, assistant coaches, athletic trainers, physicians and other practitioners of the healing arts treating me, from any and all liability, claims, causes of action or demands arising out of any injuries to my person or property, or losses of any kind and nature whatsoever, which may result from or in connection with my participation in any type of activity related to the Rockwood Summit High School team. I specifically acknowledge that wrestling is a violent and physically demanding sport involving even greater risk of injury than those other sports, and I both understand and I voluntarily assume all of those risks.

Athlete Signature:__________________________

Parent Signature:__________________________