2022 WaGiSS Conference Registration Form

Participant Information

First and Last Name *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Birthdate (mm/dd/yyyy) *

(mm/dd/yyyy)

Phone Number *

E-mail *

example@example.com

Confirm Email *

example@example.com

I am *

Sex *

Female Male (must be coach or trainer)

Age (minimum age to participate is 16 years. There is no maximum age) *

T-shirt Size (all registrants get one event shirt) *

I am interested in learning more about (select all that apply): *

Powerlifting Olympic Lifting Strongman events

I currently compete in (select all that apply): *

Powerlifting Olympic Lifting Strongman events I am a trainer

I have been active in my sport/sports: *

Less than 2 years Less than 5 years More than 5 years

My competition experience is: *

I have been training but never competed I have competed 3 times or less I have competed more than 3 times I have competed more than 8 times

I am: *

A female athlete with less than 3 years of experience A female athlete with more than 3 years experience A coach wanting to earn the Coaching Certification (you can be a female athlete and coach or a male coach)

Lodging: *

Staying in the host hotel (venue) Staying offsite I live local

The conference will begin at 8:00am Aug 12 and conclude at 5:30pm Aug 14. Please complete the following: *

***If you have a High School or Collegiate team/club who are interested in attending this event, please contact me at dsnowpfz@gmail.com. There will be a group rate for teams/clubs of 3 or more participants.***

Emergency Information

Emergency Contact's Name *

First Name Last Name

Phone Number *

Medical Release and Authorization

As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to WaGiSS and its affiliates including Instructors, Coaches, and Director to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by WaGiSS during the selected camp. In exchange for the acceptance of said child’s candidacy by WaGiSS ., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless WaGiSS . and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against WaGiSS including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Parent/Guardian Information (If participant is under 18 years of age)

Guardian's Name

First Name Last Name

Relationship

Guardian Signature

A guardian must sign this form if the participant is under the age of 18. Clear

If this event is cancelled due to COVID-19, you will recieve a full refund. If you cancel before April 1, 2022, you will recieve a full refund. No Refunds will be issued after April 1, 2022.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Participants Signature *

Clear

Purchase your own event pull-over or ladies tank at check out.