FC Youth Wrestling 24-25 Registration

'24-25 Fox Chapel Youth Wrestling Registration

*** Little Foxes program is full, please email foxchapelyouthwrestling@gmail.com to be added to the waitlist***
Athlete's Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade*
Program*

Novice/ Advanced (K-6th grade) $150
Estimated Weight (pounds)*
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name*

First NameLast Name
Cell Number*
Name

First NameLast Name
Cell Number
E-mail (please include all that wish to receive program communications)*
Emergency Information
Emergency Contact Other Than Listed Parent/ Guardian Above*

First NameLast Name
Relationship*
Phone Number*
Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.*
Is the athlete prescribed an inhaler? If yes, please explain any instructions.*
Shirt Size*

Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult Large
Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by Fox Chapel Youth Wrestling during the 2024-2025 season. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Fox Chapel Youth Wrestling and all its respective officers, agents, coaches, volunteers and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from program activities. In case of injury to said child, I hereby waive all claims against Fox Chapel Youth Wrestling 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, including wrestling. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death. We certify that our child has had a physical examination within the past six months and is physically fit to compete in the program without restrictions.
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 Fox Chapel Youth Wrestling and its affiliates including Directors, Coaches, and Team Parents 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.
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.
Registration Program Fee (please note the PayPal link will allow debit/ credit card entry)*
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Team
$150.00

Team Sibling
$125.00

Total

$0.00
Pay with PayPal

Please click one of the PayPal options to complete payment and submit the form.
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'24-25 Fox Chapel Youth Wrestling Registration