1. Scanzano Sports Center 5 Carnegie Plaza Cherry Hill, NJ 08003
***** Registration and Liability Waiver*****
Scanzano Sports Center 5 Carnegie Plaza Cherry Hill, NJ 08003
First Name_________________________Last Name_______________________________Birthdate____________
Address _____________________________________________________ Age (as of April 1st this year)________
City____________________________________State_______Zip Code_______________ Grade ______________
Home Phone__________________________________ School_________________________________________
Wrestlers Cell #________________________ Parents ____________________________________________
USA Card number/expiration: _____________________________________________________
Parent Name______________________________ Parent Cell #_____________________________
Other than the parents:
Emergency Contact____________________________________________ Phone_________________________
REGISTRATION DETAILS Workouts for all grades are:
Mondays and Wednesdays from 7-8:30 p.m.
Saturday’s from 10-11:30 a.m.
MEMBERSHIP RATES:
Drop in Card - 5 workouts for $125
Month to Month - $150
3 Months - $400
6 Months - $750
1 Year - $1200
**Each additional family member is 50% off the Membership Rate**
**Private sessions are available upon request**
Pay by cash or check; Checks made payable to Combat Wrestling
USA Wrestling cards are REQUIRED and can be purchased onsite for $40, or through
**NO ONE WORKS OUT WITHOUT A VALID USA CARD AND CLUB MEMBERSHIP**
ALL REGISTERED ATHLETES GRADES 9-12 MUST LIVE WITHIN A 50 MILE RADIUS OF RIDER UNIVERSITY, LAWRENCEVILLE, NJ (as the crow flies)
**********Consent, Liability Waiver and Medical Release**********
To the best of my knowledge, the information above is correct and complete. I give permission for my child to participate in all activities of the COMBAT Wrestling Club. In the event that I cannot be reached in an emergency, accident or injury which occurs while this minor is participating in any activity of the COMBAT Wrestling Club, I hereby give permission for the representatives of the COMBAT Wrestling Club to secure whatever medical or hospital care that may be necessary, and I agree to be financially responsible for such care. I further hold the COMBAT Wrestling Club and any of their representatives, officers, directors and coaches harmless from and indemnify them against any liability, loss, or injury incurred in connection with participation in the activities of the COMBAT Wrestling Club, or as the result of any treatment rendered pursuant to the permission to secure medical attention for the minor named above. Furthermore, I indemnify and hold harmless, King’s Christian School and the Scanzano Sports Center and its trustees for any injury or loss incurred as a participant in activities of the COMBAT Wrestling Club. I agree to be financially responsible for the loss or careless destruction caused by my child of any property of the COMBAT Wrestling Club, King’s Christian School or the Scanzano Sports Center. The COMBAT Wrestling Club is a separate entity from King’s Christian School and is a limited liability corporation not owned or controlled by the King’s Christian School.
____________________________________________________ ___________________________
Signature (Parent or Legal Guardian) Date
Dues Paid Date: Amount: Check Number: