2022-23 Youth Registration Form

2022-23 Youth Registration Form

Grades K-5
Number of Registrations*

One WrestlerTwo WrestlersThree WrestlersFour Wrestlers
Wrestler Name #1*

First Name Middle Name Last Name
Wrestler Name #2*

First Name Middle Name Last Name
Wrestler Name #3*

First Name Middle Name Last Name
Wrestler Name #4*

First Name Middle Name Last Name
Gender #1

MaleFemale
Gender #2

MaleFemale
Gender #3

MaleFemale
Gender #4

MaleFemale
Birth Date #1*

Month Day Year
Birth Date #2*

Month Day Year
Birth Date #3*

Month Day Year
Birth Date #4*

Month Day Year
T-Shirt Size #1*

Youth SYouth MYouth LAdult SAdult MAdult L
T-Shirt Size #2*

Youth SYouth MYouth LAdult SAdult MAdult L
T-Shirt Size #3*

Youth SYouth MYouth LAdult SAdult MAdult L
T-Shirt Size #4*

Youth SYouth MYouth LAdult SAdult MAdult L
Grade #1*
Grade #2*
Grade #3*
Grade #4*
School Attending*
as applicable
Wrestler(s) Primary Lives With*
Father Full Name

First Name Last Name
Father E-mail
Father Phone

Area Code Phone Number
Father Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Mother Full Name

First Name Last Name
Mother E-mail
Mother Phone

Area Code Phone Number
Mother Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Guardian Full Name

First Name Last Name
Guardian E-mail
Guardian Phone

Area Code Phone Number
Guardian Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Emergency Contact: if parent or guardian CANNOT be reached.*

First Name Last Name
Emergency Contact Phone

Area Code Phone Number
Emergency Contact Relationship to Wrestler
Primary Physician

Prefix First Name Last Name
Primary Physician Phone

Area Code Phone Number
Medications and Prescriptions - Wrestler 1
Medications and Prescriptions - Wrestler 2
Medications and Prescriptions - Wrestler 3
Medications and Prescriptions - Wrestler 4
Known allergies, considerations or health instructions - Wrestler 1
Known allergies, considerations or health instructions - Wrestler 2
Known allergies, considerations or health instructions - Wrestler 3
Known allergies, considerations or health instructions - Wrestler 4
Photo & Release Permission

Photos and video clips will be taken during practices and events and may be used in marketing materials for River Falls Wrestling Boosters, Inc. (RFW). By signing below, I give permission to record my child's image, voice, statements and/or writing to RFW. Note: personal individual identification, names and name tagging will not be used. I further irrevocably grant to RFW, its advertisers, clients, agents, successors and assigns, unrestricted rights to use the above mentioned sound, still, or moving images in any medium for educational, promotional, advertising, or other purposes without limitation consistent with the mission of RFW. I agree that all rights to the sound, still, or moving images belong to RFW. I voluntarily waive the right to inspect or approve such images. This release is effective on the date written below and will remain in effect indefinitely.
Photo Release & Permission*

No, I Do NOT Give PermissionYes, I DO Give Permission and Agree to Photo Release
Agreement

I, the parent / legal guardian of the registrant(s), minor(s), agree that registrant(s) and I recognize the possibility of physical injury associated with wrestling, I hereby release, discharge, and / or otherwise indemnify River Falls Wrestling Boosters, Inc. (RFW) including the sponsors, their employees, and associated personnel, including the owners of the facilities utilized for the program, against any and all claims by or on behalf of the registrant as a result of the registrant’s participation in the program. River Falls Wrestling Boosters, Inc., the coaching staff and the River Falls School District cannot be held liable for injuries sustained during practice or events. Wrestlers not adhering to the rules of the practices will be asked to leave. We will not be responsible for any child asked to leave early. Please inform your child of this rule and be prepared to provide early transportation home if your child or children are asked to leave.
Agreement Acknowledgment*

I agree to the above.
Agreement Acknowledgment*

I agree to the above.
Concussion Acknowledgment Parent & Athlete Agreement

Must Read Before Continuing:
- Wisconsin Fact Sheet For Parents
- Wisconsin Fact Sheet for Athletes
As a Parent and as an Athlete it is important to recognize the signs, symptoms, and behaviors of concussions. By signing this form you are stating that you understand the importance of recognizing and responding to the signs, symptoms, and behaviors of a concussion or head injury. I have read the Parent Concussion and Head Injury Information and understand what a concussion is and how it may be caused. I also understand the common signs, symptoms, and behaviors. I agree that my child must be removed from practice/play if a concussion is suspected. I understand that it is my responsibility to seek medical treatment if a suspected concussion is reported to me. I understand that my child cannot return to practice/play until providing written clearance from an appropriate health care provider to his/her coach. I understand the possible consequences of my child returning to practice/play too soon.
Concussion Agreement*

I have read, understand and agree to the concussion acknowledgement agreement for both athletes and parents.
COVID-19 Waiver

By agreeing and signing below, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending River Falls Youth Wrestling (RFYW) activities and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at RFYW may result from the actions, omissions, or negligence of myself and others, including, but not limited to, RFYW employees, volunteers, and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at the RFYW (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless River Falls Wrestling Boosters, Inc., its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of River Falls Wrestling Boosters, Inc., its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any RFYW program.
COVID-19 Waiver Acknowledgment*

I agree to the above COVID-19 Waiver
Parent / Guardian Signature (Sign in the Box with Mouse or Curser)*

Clear
Enter the message as it's shown*
Registration Fee Information

Registration is $100 per wrestler for Grades PreK-2 and $150 per wrestler for Grades 3-5. Fees include a USAW Wrestling Membership, River Falls Wrestling T-shirt, and year end party.

VOLUNTEER REQUIREMENT: All youth wrestling families will be required to volunteer to serve in a variety of areas within the program. Volunteer opportunities include the Northern Badger High School Tournament (December 29-30, 2022) and the Regional Youth Qualifier Tournament (March 18, 2023). Both events are at River Falls High School.

A $100 volunteer fee must be submitted prior to participation (present a check made out to River Falls Wrestling Booster Club that the club will hold until the end of the season. The check will be cashed if volunteer responsibilities are not met. Alternatively, you can select Opt Out and pay the non-refundable Opt-Out fee below).
I agree with the volunteer requirement.*

I agree
Checkout*
prevnext( X )
2022-23 River Falls Youth Wrestling Registration Fee (PreK-2)$100.00

Quantity

2022-23 River Falls Youth Wrestling Registration Fee (Grades 3-5)$150.00

Quantity

Family Volunteer Commitment Opt-Out$100.00
Youth Families may opt-out of the 5 hour volunteer commitment with this fee (non refundable).

Total $0.00
Before submitting form, please consider liking us on Facebook for updates, photos and additional information.
Should be Empty:

2022-23 Youth Registration Form

Concussion Acknowledgment Parent & Athlete Agreement