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REGISTRATION FORM
Athlete Information
Child's Name
Parent/Guardian Name
Phone
Parent/Guardian Name
Phone
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EMERGENCY CONTACT
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MEDICAL INFORMATION
Hospital/Clinic Preference
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Insurance Company
I authorize all medical and surgical treatment, X-ray, laboratory, anesthesia, and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment. This waiver applies only in the event that neither/guardian can be reached in the case of an emergency.
I give permission for my child to attend away games. I release The Riot Room and individuals from liability in case of accident during activities related to The Riot Room, as long as normal safety procedures have been taken.
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Wrestling Season (register after 11/1) - $450
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