4.25 From the Bay to the Mat Registration

1
Wrestler NamePlease type in the name of the wrestler registering
First Name
Last Name
2
Wrestler Email
example@example.com
3
Phone Number
Please enter a valid phone number.
4
Wrestler's Date of Birth
Date
Year
Month
Day
5
Wrestler's Gender
Male
Female
6
BTSBA Athlete?
YESNO
7
Home AddressPlease fill out the home address of the wrestler.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
8
Parent/Guardian Name
First Name
Last Name
9
Parent/Guardian Phone Number
Please enter a valid phone number.
10
Parent/Guardian Email
example@example.com
11
Emergency Contact Name
First Name
Last Name
12
Relationship to Wrestler
13
Emergency Contact Phone Number
Please enter a valid phone number.
14
Club/School of Wrestler
15
Parent/Guardian Recreational Sport Assumption of Risk and Release of LiabilityIn 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. Section 2 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.
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