Registration - Beat the Streets Detroit Wrestling Program

"*" indicates required fields

Athlete Information

What is your age group?*

What site do you primarily train at?*

Athlete Email*

Athlete First Name*

Athlete Middle Name

Athlete Last Name*

Athlete Birth Date*

Home Phone or Parent/Guardian Phone*

Athlete's Phone Number

(so coach can get in touch with you)

Athlete Headshot or Photo

Accepted file types: jpg, png, gif, bmp, pdf, Max. file size: 32 MB.

File formats accepted: jpg, png, gif, bmp, and pdf. So that we can easily identify the athlete.

Gender*

Ethnicity*

Primary Language Spoken at Home*

School*

Current Grade*

High School Graduation Year (if known)

Street Address*

Apartment Number, PO Box, etc.

City*

State*

Zip*

Parent/Guardian Info

Primary Parent/Guardian First Name*

Primary Parent/Guardian Last Name*

Primary Parent/Guardian Email*

Primary Parent/Guardian Phone*

Secondary Parent/Guardian First Name

Secondary Parent/Guardian Last Name

Secondary Parent/Guardian Email

Secondary Parent/Guardian Phone

Medical & Insurance

Does the athlete have any allergies?*

List of allergies*

Is the athlete taking any medications?*

List of medications*

Has the athlete ever been diagnosed with a concussion?*

Please list any additional medical conditions

Emergency Contact Name (not the athlete's parent)*

First Last

Emergency Contact Phone Number*

Emergency Contact Email*

Emergency Contact's Relationship to Athlete*

Medical Insurance Policy Holder

Medical Insurance Company

Medical Insurance Phone Number

Medical Insurance Policy Number

Medical Insurance Group Number

Waivers & Releases

Waiver and Release of Liability*

I agree to the Waiver and Release of Liability

IN CONSIDERATION of being permitted to participate in any way in any activity, practice, program or other event (collectively, "Activity") at any time during my participation with Beat the Streets Detroit I, for myself, my personal representatives, assigns, heirs, all children, and any next of kin ACKNOWLEDGE, agree, and represent that I understand the nature of the Activity and that I am qualified, in good health, and in proper physical condition to participate in such Activity. I further agree and warrant that if, at any time, I believe the conditions to be unsafe, I will immediately discontinue further participation in the Activity.
FULLY UNDERSTAND that: (a) THIS ACTIVITY INVOLVES RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS, AND DEATH ("Risks"); (b) these Risks and dangers may be caused by my own actions or inactions, the actions or inactions of others participating in the Activity, the conditions in which the Activity takes place, or THE NEGLIGENCE OF THE "RELEASEES" NAMED BELOW; (c) there may be OTHER RISKS or SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation ,or that of the minor, in the Activity.
I HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE Beat the Streets Detroit Wrestling Inc. Detroit Public Schools Community District, Detroit Parks and Recreation, and their respective board members, officers, employees, agents, volunteers, contractors , sponsors, and affiliates (collectively, “Releasees”) officers, members, volunteers, contractors, sponsors, affiliates and employees, other participants, officials, rescue personnel, sponsors, advertisers, owners and lessees of Premises on which the Activity is conducted, (each of the forgoing shall be considered one of the RELEASEES herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED, OR ALLEGED TO BE CAUSED, IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS; AND I FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, or anyone on my behalf, makes a claim against any of the Releasees, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expenses, attorney fees, loss, liability, damage, or cost which may be incurred as the result of such claim.
I hereby give my consent to have an athletic trainer, coach, emergency medical technician, nurse, medical treatment facility, and/or doctor of medicine or dentistry or associated personnel provide the wrestler with medical assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or treatment. I understand treatment for injury will be based on information provided herein. I hereby authorize emergency transportation of the wrestler to a medical treatment facility should an individual listed above consider it to be warranted. I hereby authorize the use of the above-named wrestler’s name and image in promotional publications and media for Beat the Streets Wrestling Inc.
I ACKNOWLEDGE THAT I HAVE HAD SUFFICIENT OPPORTUNITY TO REVIEW THE PROVISIONS OF THIS DOCUMENT AND UNDERSTAND ITS PURPOSE, MEANING, AND INTENT. I ACKNOWLEDGE THAT I AM OVER THE AGE OF 18 YEARS, HAVE READ THIS AGREEMENT AND FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE, AND I INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID, THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.
I further give my consent for the above-named wrestler to travel to BTS programming, both in and out of the city, and ride on BTS provided transportation including but not limited to cars, vans, buses and with one of our coaches in a private automobile.
Minor Release
AND I, THE MINOR'S PARENT AND/OR LEGAL GUARDIAN, UNDERSTAND THE NATURE OF THE ACTIVITY AND THE MINOR'S EXPERIENCE AND CAPABILITIES AND BELIEVE THE MINOR TO BE QUALIFIED, IN GOOD HEALTH, AND IN PROPER PHYSICAL CONDITION TO PARTICIPATE IN SUCH ACTIVITY. I HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS EACH OF THE RELEASEE'S FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON THE MINOR'S ACCOUNT CAUSED, OR ALLEGED TO BE CAUSED, IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE "RELEASEES" OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS AND FURTHER AGREE THAT IF, DESPITE THIS RELEASE, I, THE MINOR, OR ANYONE ON THE MINOR'S BEHALF MAKES A CLAIMS AGAINST ANY OF THE RELEASEES NAMED ABOVE, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES FROM ANY LITIGATION EXPENSES, ATTORNEY FEES, LOSS LIABILITY, DAMAGE, OR ANY COST THAT MAY OCCUR AS A RESULT OF ANY SUCH CLAIM.
COVID-19 Waiver
Assumption of Risk and Waiver of Liability Relating to Coronavirus/COVID-19
The novel coronavirus, COVID-19, has been declared worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to be spread from person-to-person contact. As a result, federal, state, and local governments and state and local health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people.
The Releasees have put in place preventative measures to reduce the spread of Covid-19; however, the Releasees cannot guarantee that your child(ren) or you will not become infected with COVID-19. Further, attending an Activity could increase your child(ren) and your risk of contracting COVID-19.
By signing this agreement, you acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that your child(ren) or you may be exposed or infected by COVID-19 by attending an Activity and that such exposure or infection may result in personal injury, illness, permanent disability, and death. You further acknowledge that you understand that the risk of your child(ren) or you being exposed to or infected by COVID-19 at any Activity may result from the acts, omissions, or negligence of you, your child(ren), and others, including, but not limited to, the Releasees or any of their respective families.
Further, you voluntarily agree to assume of the foregoing risks and accept sole responsibility for any injury to your child(ren) and you (including, but not limited to, personal injury, death, or disability), illness, damage, loss, claim, liability or expense of any kind, that you or your child(ren) may experience or incur in connection with attendance at any Activity. On behalf of yourself and your child(ren), you hereby release, covenant not to sue, discharge, and hold harmless, the Releasees and each of their respective families, of and from all liabilities, claims, actions, damages, costs, or expenses of any kind, arising out of or relating thereto (collecting, the “Claims”). In addition, you acknowledge and agree that this release includes any Claims based on the actions, omissions, or negligence of the Releasees or any of their respective families, whether or not a COVID-19 infection occurs before, during, or after participation in any Activity.
My child’s participation in the Program is voluntary and accordingly, I, on behalf of myself, my child, and family, agree to the following:
a. I hereby authorize BTSD to transport or arrange transportation for my child to and from the Program.
b. I recognize the physical exertion involved in the program and I attest and certify that my child is physically fit to compete safely, and I have not been advised by a medical professional otherwise that my child should not/cannot compete.
c. As between each of the Releasees and me, I will be solely responsible for any and all medical and related bills that I or my child may incur because of my child’s participation in the Program, including those sustained on the premises where the Program is conducted and while I or my child am traveling to and from such premises, regardless of the location or mode of transportation.
d. This Agreement shall be binding on my child’s and my estate, heirs, executors, administrators, successors, and assigns, as well as any other party asserting a Claim on my behalf or on behalf of my estate.

Parent/Guardian Signature*

Today's Date*