Student-Athlete Information
Program/School Site
*
Please Select
Oakland Housing Authority
Name
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First Name
Last Name
Gender
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Male
Female
Other
Date of Birth
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-
Month
-
Day
Year
Date
Grade (2025-2026)
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Please Select
3rd
4th
5th
6th
How long have you been at Beat the Streets Bay Area?
*
Please Select
This is my first year
2 years
3 years
4 or more years
Are you currently or have been unhoused?
*
Please Select
Yes
No
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Select Sizing Type
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Women's
Men's
Youth
Shoe Size
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Please Select
1
1.5
2
2.5
3
3.5
4
4.5
5
5.5
6
6.5
7
7.5
8
8.5
9
9.5
10
10.5
11
11.5
12
12.5
13
13.5
14
Shirt Size
*
Please Select
XS
S
M
L
XL
XXL
XXXL
Short Size
*
Please Select
XS
S
M
L
XL
XXL
XXXL
Sports Bra Size
*
Please Select
N/A
XS
S
M
L
XL
XXL
XXXL
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Primary Guardian Information
*
First Name
Last Name
Primary Guardian Phone Number
*
Please enter a valid phone number.
Primary Guardian Alternate Phone Number
*
Please enter a valid phone number.
Primary Guardian Email
*
example@example.com
Primary Guardian Preferred Language
*
English
Spanish
Vietnamese
Other
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Secondary Guardian Information
First Name
Last Name
Primary Guardian Phone Number
Please enter a valid phone number.
Primary Guardian Alternate Phone Number
Please enter a valid phone number.
Primary Guardian Preferred Language
English
Spanish
Vietnamese
Other
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Health Insurance Information
Primary Insured
*
Please Select
Mother
Father
Grandparent
Other
Provider Name
Policy Number #
Group Number
Provider Phone Number
Please enter a valid phone number.
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Preseason Survey
Please answer each question below. Your responses help make our programs better for you and all future student-athletes and ensure that BTSBA can continue to fund programs thanks to the generosity of private donors, foundation grants, and government entities.
Ethnicity
*
Please Select
American Indian or Alaskan Native
Asian
Black or African-American
Hispanic or Latinx
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
White
Multi-ethnic
Prefer not to disclose
Does anyone in your household qualify for Free and Reduced lunch at school?
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Yes
No
What is the highest level of education you think you will complete?
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High School
2- year College/Community College
4 year college
Graduate School (Masters, Law, Medicine, etc)
What is the highest level of education your Primary Guardian has?
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Did not complete High School
High School Degree
2- year College/Community College
4 year college
Graduate School (Masters, Law, Medicine, etc)
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How many adults in your life do the following?
Help you with your school work?
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None
1
2
3
4 or more
Can be counted on for help if you had a big problem?
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None
1
2
3
4 or more
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Read each statement below and tell us how well it describes you.
I keep going, even when things get tough or stressful.
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1 Does NOT describe me at all
2
3 Sort of Describes me
4
5 Descrives me VERY well
It is important for me to participate in my community.
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1 Does NOT describe me at all
2
3 Sort of Describes me
4
5 Descrives me VERY well
I can deal with my emotions when I'm disappointed.
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1 Does NOT describe me at all
2
3 Sort of Describes me
4
5 Descrives me VERY well
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Read each statement below and tell us how well it describes you.
It's important for me to work hard in school.
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1 Does NOT describe me at all
2
3 Sort of Describes me
4
5 Descrives me VERY well
I am confident I can do well in school.
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1 Does NOT describe me at all
2
3 Sort of Describes me
4
5 Descrives me VERY well
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Read each statement below and tell us how well it describes you.
I believe that finishing school will help me achieve my goals.
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1 Does NOT describe me at all
2
3 Sort of Describes me
4
5 Descrives me VERY well
If things get tough or stressful, I have a way to deal with it (such as counting to 10, exercising, talking to someone).
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1 Does NOT describe me at all
2
3 Sort of Describes me
4
5 Descrives me VERY well
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Read each statement below and tell us how well it describes you.
I frequently set goals for myself.
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1 Does NOT describe me at all
2
3 Sort of Describes me
4
5 Descrives me VERY well
If I set goals, I take steps to reach them.
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1 Does NOT describe me at all
2
3 Sort of Describes me
4
5 Descrives me VERY well
It is important to me that I reach my goals.
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1 Does NOT describe me at all
2
3 Sort of Describes me
4
5 Descrives me VERY well
I feel that I have a lot of good qualities.
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1 Does NOT describe me at all
2
3 Sort of Describes me
4
5 Descrives me VERY well
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Read each statement below and tell us how well it describes you.
I believe in myself.
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1 Does NOT describe me at all
2
3 Sort of Describes me
4
5 Descrives me VERY well
The groups I belong to (such as my team, school, community, family, church, etc.) are good for me.
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1 Does NOT describe me at all
2
3 Sort of Describes me
4
5 Descrives me VERY well
The friends I spend time with make me a better person.
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1 Does NOT describe me at all
2
3 Sort of Describes me
4
5 Descrives me VERY well
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Thank you for completing the survey!
Please continue the registration on the next page.
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Parent/Guardian Recreational Sports Assumption of Risk, Waiver, and Release of Liability.
In consideration of my son’s/daughter’s participation in the Beat the Streets Bay Area Wrestling Program at the above named location (the “Wrestling Program”), and the use of the property, facilities and/or services of Beat the Streets Bay Area and its participating or sponsoring organizations, including schools and/or after- school program providers, I agree as follows: A. RISK FACTORS: I understand and acknowledge that wrestling is a strenuous contact sport that may, on occasion, cause injuries. I also understand that children with certain medical conditions could be impacted adversely by strenuous activity that increases the child's heart rate, blood pressure or breathing. I understand and agree that I am responsible for ensuring that my child is physically able to participate in youth wrestling and training activities, and I accept and assume all risks of injury, whether to my child or others that may result from my child's participation in the Wrestling Program or any other Beat the Streets Bay Area wrestling event, the use of any equipment or facilities provided or used by Beat the Streets Bay Area and its participating or sponsoring organizations, the sport of wrestling, the acts of others or the unavailability of emergency care. I am not aware of any medical reason why my child should not participate in the Wrestling Program. I understand and agree that if I have any questions as to what skills, qualifications or training is necessary for my child to participate in the Wrestling Program, then I will direct such questions to my child's coach or the appropriate Beat the Streets Bay Area staff member on site. B. ACKNOWLEDGEMENT OF POLICIES AND PROCEDURES: I understand the importance of Advising and have advised my child to comply with the instructions of his or her coach and the rules and regulations for safe participation in the Wrestling Program. I understand that the safe and proper use of the facilities and equipment provided by Beat the Streets Bay Area and its participating or sponsoring organizations, and the safe participation in the Wrestling Program by my child, is dependent upon carefully following such instructions, rules and regulations. C. EMERGENCY TREATMENT CONSENT: I hereby grant Beat the Streets Bay Area and its authorized representatives permission for any and all medical and/or dental attention to be administered to my child in the event of an accidental injury or illness, until such time as I can be contacted. D. RELEASE I hereby forever and completely RELEASE Beat the Streets Bay Area, its officers, directors, employees, staff, contractors and coaches, and their respective agents, insurers, heirs, successors, attorneys, corporate affiliates and predecessors, from any and all claims, disputes, causes of action, which may arise out of any participation in Beat the Streets by my child or by others in my child’s presence, or out of all acts or equipment, buildings or the grounds, or the condition thereof, used by Beat the Streets, and AGREE NOT TO SUE OR FILE A CLAIM against them on account of or in conjunction with any claims, causes of action, injuries, damage, cost of expenses arising out of the Wrestling Program or otherwise, including those based on death, bodily injury or property damage whether or not caused by the acts, omissions or other fault of the parties being released. E. INDEMNITY: I agree to INDEMNIFY, DEFEND, AND HOLD Beat the Streets Bay Area and its officers, directors, employees and coaches, and their respective agents, insurers, heirs, successors, attorneys, corporate affiliates and predecessors (hereinafter jointly referred to as “Indemnitee”) HARMLESS from any or all claims, causes of action, damages, judgments, costs and expenses, including attorney fees, which in any way arise from the activity or this Release which include but are not limited to damages to or destruction of any property of Indemnitee, of any others, injury or death of my child or anyone else or any liability arising from the act or negligent act of Indemnitee, me, my child or anyone else.F. USE OF NAME AND LIKENESS I authorize the use of my child's name and image in promotional or informational publications for Beat the Streets Bay Area and the Wrestling Program, which may be published, among other ways, on the Beat the Streets Bay Area website. G. REPRESENTATIVE CAPACITY: I am entering into this Release for myself, my child and our respective heirs, assigns and legal representatives. H. INSURANCE: I understand that Beat the Streets Bay Area does not carry participant health insurance. I agree that it is my responsibility to determine whether my child should have a physical examination prior to my child's participation in the Wrestling Program, or whether I should purchase health insurance for my child. I. STEROID PROHIBITION: I agree that my child will not use steroids without the written prescription of a fully licensed physician (as recognized by the AMA) to treat a medical condition. I recognize that the governing district policy of the school my child is participating at regarding the use of illegal drugs will be enforced for any violations of these rules. Intending for Beat the Streets Bay Area to rely on this Release, I hereby represent and warrant that I have carefully read this Release, that I have had the opportunity to confer with legal counsel of my choice concerning this Release and its terms before executing this document and before my child participates in the Wrestling Program, and that I sign this Release knowingly and voluntarily, intending to be legally bound hereby. Please provide your signature below.
If you accept these terms and conditions, please sign here:
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Please check this box if you accept these terms and conditions and agree to allow your child to participate in the 2025 South Bay Wrestling League presented by BTSBA and Evergreen School District.
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I acknowledge these terms and conditions.
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