Jr. Club Medical Release & Waiver Forms

BOTH MEDICAL RELEASE AND USA WRESTLING WAIVER MUST BE FILLED OUT:

Click and Download BOTH waivers:  Medicalwaivers and Medical Release Form

Durham Wrestling Club

Medical Release Form

Insurance Company: ______________________________ Policy#: ____________________

Primary Care Physician:_______________________________ Ph#_____________________

Is your child allergic to any food? YES / NO    If yes, please explain: _______________

____________________________________________________________________________

Is your child allergic to any medications? YES / NO      If yes, please explain: _______

____________________________________________________________________________

Authorization To Treat A Minor

Please choose one of the following

  1. If my child needs medical treatment, it is my wish that I be contacted BEFORE any medical procedures begin, unless immediate treatment is necessary to save my child’s life or prevent permanent injury. I accept responsibility for all costs related to such treatment. By signing below, I understand that my child is involved in a wrestling program where injuries can occur. My child has my permission to participate in the wrestling program.

Parent/Guardian: ________________________________Date: _______________

  1. If my child needs medical treatment while participating, it is my wish that the treatment be started while efforts are being made to contact me, so that treatment is not delayed. I consent to any medical procedures while attempts to contact me are continued to be made. I accept responsibility for all costs related to such treatments. By signing below, I understand that my child is involved in a wrestling program where injuries can occur. My child has my permission to participate in the wrestling program.

Parent/Guardian: __________________________Date: ______________

Parent Consent & Liability Waiver

I desire for my minor child to participate in the Durham Wrestling Club’s practices and wrestling events that are being offered. I understand that wrestling involves physical contact between wrestlers and I accept the risk associated with participation. My child has no known medical conditions which prohibit participation in this sport. I agree to hold harmless and release the Durham Wrestling Club and their agents and sponsors from legal liability resulting from any injuries sustained during participating in these activities. I understand the Durham Wrestling Club cannot be responsible for loss or damage to my child’s personal possessions. I give permission for my child’s photograph to be used.

Parent/Guardian: ______________________________  Date: _______________