2021-2022 Season Registration - Topeka Blue Thunder

2021-2022 Topeka Blue Thunder Season Registration

This form is for getting TBTWC the necessary personal information to sign your child up for the 2021-2022 wrestling season. Please be advised that you will still need to pay for your USAW Insurance card(mandatory) & registration fee(per family) and membership dues(per wrestler) before your child will be fully registered. You can purchase your USAW card starting September 1st usawmembership.com. Registration and membership dues can be paid through the our website store.

Step 1 of 5

How many wrestlers do you have?*
Wrestler Information
Wrestler Name*
First Middle Last
Nickname
Gender*
- Male
- Female
Wrestler Date of Birth*
Month
Day
Year
Age as of August 31st, 2021*
Grade*
Years of Experience*
Approximate Weight*
School Attending*
School Attending - Other*
Shirt Size*
Wrestler Information #2
Wrestler Name*
First Middle Last
Nickname
Gender*
- Male
- Female
Wrestler Date of Birth*
Month
Day
Year
Age as of August 31st, 2021*
Grade*
Years of Experience*
Approximate Weight*
School Attending*
School Attending - Other*
Shirt Size*
Wrestler Information #3
Wrestler Name*
First Middle Last
Nickname
Gender*
- Male
- Female
Wrestler Date of Birth*
Month
Day
Year
Age as of August 31st, 2021*
Grade*
Years of Experience*
Approximate Weight*
School Attending*
School Attending - Other*
Shirt Size*
Wrestler Information #4
Wrestler Name*
First Middle Last
Nickname
Gender*
- Male
- Female
Wrestler Date of Birth*
Month
Day
Year
Age as of August 31st, 2021*
Grade*
Years of Experience*
Approximate Weight*
School Attending*
School Attending - Other*
Shirt Size*

Primary Parent/Guardian Information
Who do we contact 1st in case of questions or emergencies?
Name*
First Last
Relationship*
Email Address*
Primary Phone*
Alternate Phone
Address*
Street Address Address Line 2 City State ZIP Code

Secondary Parent/Guardian Information
Who do we contact 2nd in case of questions or emergencies?
Name*
First Last
Relationship*
Email Address
Primary Phone*
Alternate Phone
Address*
Street Address Address Line 2 City State ZIP Code

Medical and/or Need To Know Information About My Child
We will not release any information unless a medical situation requires.
Medical History/Need To Know Information*
Please list any medical history/allergies/limitations that would be helpful to coaching and medical staff.
If none please put NA. If more than one wrestler notate each wrestler by name.
Preferred Hospital

Consent Acknowledgement
Topeka Blue Thunder Wrestling Club Release of Liability – Read Before Signing In consideration of my minor child (“my child”) being allowed to participate in this wrestling club and its related events and activities, I, the undersigned, acknowledge, appreciate, and agree that: The risk of serious injury from wrestling is always present due to the nature of the sport, which presents risks that cannot be eliminated, regardless of the care taken to avoid injuries and illness. I understand that my/my child's participation in TBTWC practices, activities, camps, and use of wrestling facilities is completely voluntary in all respects and I assume all risks of injury, illness and/or death to my child or others that may result from such use; and I understand that the dangers and risks of practicing and competing in wrestling include, but are not limited to, transmittable disease - including Covid-19 and the transmittal thereof, disorders, death, serious neck and spinal injuries which may result in complete or partial paralysis, brain damage, blindness, serious injury to virtually all internal organs, serious injury to virtually all bones, joints, ligaments, muscles, tendons and other aspects of the musculoskeletal system, and serious injury or impairment to other aspects of my body, general health and well-being. I understand that the dangers and risks of practicing or competing in wrestling may result not only in serious injury, but in a serious impairment of my future abilities to earn a living, to engage in other business, social and recreational activities and generally to enjoy life. THUS, FOR MYSELF, SPOUSE, AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my child’s participation; and I have fully informed myself of the most recent national, state and local government orders, warnings and instructions as they pertain to Covid-19, and I have fully informed myself of the risks associated with my child participating at TBTWC practices, activities and camps in light of said orders, warnings and instructions. Having been so informed, FOR MYSELF, SPOUSE, AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my child’s participation; and I fully agree, and warrant my compliance, to TBTWC’s stated and customary terms and conditions for my child’s participation, including, but not limited to: (a) I will ensure my wrestler is 15 minutes early for pre-practice protocol (checking of temperature, sanitation, etc.), (b) I will timely communicate to the parents of my wrestler’s assigned wrestling partner if my child will not be present at practice; (c) Neither I, nor my wrestler’s siblings will enter any TBTWC facility, (d) I will not send my wrestler to practice nor allow him/her to participate in any TBTWC event if he/she has exhibited any of the following symptoms in the previous 72 hours: cough, shortness of breath, fever (100 F or more), chills, muscle pain, headache, sore throat all required protocols and conditions, (e) I will not send my wrestler to practice nor allow him/her to participate in any TBTWC event if I, my wrestler and/or my wrestler’s siblings have been exposed to someone with COVID-19 symptoms in the previous 14 days. If I observe any unusual concern in my child’s readiness or capability for participation, I will remove my child from participation and will immediately bring such to the attention to TBTWC; and I acknowledge and agree that TBTWC and its agents, and employees are not health care practitioners and that they cannot be expected to diagnose and/or treat individual health problems and/or injuries. I further acknowledge that TBTWC practices, activities and camps do not have health care practitioners to diagnose and/or treat individual health problems and/or injuries. I understand that the dangers and risks of allowing my child to participate in TBTWC practices, activities and/or camps without the presence of a health care practitioner include, but are not limited to, failure to recognize a participant with a transmittable disease - including Covid-19, delay in emergency medical treatment, failure to recognize exacerbation of injury and death. THUS, FOR MYSELF, SPOUSE, AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my child’s participation; and I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS TBTWC, its affiliates, officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used for activity (“Releases”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, OR LOSS OR DAMAGE TO PERSON OR PROPERTY, regarding my child and/or arising from his/her activities, including the transmission of COVID-19 to any individual, WHETHER ARISING FROM NEGLIGENCE OF THE RELEASEES OR OTHERWISE, except for willful misconduct, or otherwise to the fullest extent of the law. This is a complete and irrevocable release and waiver of liability. Specifically, and without limitation, I hereby release the Released Parties from any liability, claim, or cause of action arising out of the Released Parties' negligence. I covenant not to sue the Released Parties from any alleged liabilities, claims, or cause of action release hereunder I HAVE READ THE RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND THEIR TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Full Name of Parent/Guardian*
I grant the Topeka Blue Thunder Wrestling Club permission to use my wrestler's picture and/or name on the Club website, social media sites and press releases for local media.
Full Name of Parent/Guardian*
All NEW wrestlers will need to provide a copy of their birth certificate. EVERYONE will need to sign USA Wrestling medical release and wavier in order to practice until USAW cards come in at which point your will have to sign your USAW card and return to Coach Hogan to be sent to USAW.
Full Name of Parent/Guardian*
Phone
This field is for validation purposes and should be left unchanged.

2021-2022 Topeka Blue Thunder Season Registration

Step 1 of 5

Wrestler Information

Wrestler Information #2

Wrestler Information #3

Wrestler Information #4

Primary Parent/Guardian Information

Secondary Parent/Guardian Information

Medical and/or Need To Know Information About My Child

Consent Acknowledgement