The 5 Points Wrestling Club ("5PW") is not affiliated with the Uniondale School District or Hardvard Westlake Schools. The 5PW is an unincorporated association whose purpose is to promote and facilitate wrestling in the our communities.

I certify to 5PW that my child is in good physical health and has my permission to participate in all activities conducted or sponsored by the 5PW. My child has no previous sickness, illness, disease or bodily injury which is contradictory to participation.

I am aware that wrestling is a high-risk sport and that practicing or competing in wrestling will be a dangerous and unpredictable activity involving many risks of injury. I understand that the dangers and risk of practicing and competing in wrestling include, but are not limited to, 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 my child's body, general health and well-being. I understand that the dangers and risk of practicing or competing in wrestling may result not only in serious injury, but in a serious impairment of my child's future abilities to earn a living, to engage in other business, social and recreational activities and generally to enjoy life.

As a parent/guardian of the child named below, in consideration of the Association's acceptance of my child as a member on behalf of myself and my spouse and child, I hereby give my consent and approval for my child to become a member of the 5PW and engage in all activities related to the 5PW, including, but not limited to, trying out, practicing and competing in wrestling and I hereby on behalf of myself, my spouse and my child assume all the risks normally associated with wrestling and agree, to the maximum extent permitted by law, to release and hold the 5PW, its directors, officers, members, employees, agents, representatives, coaches, and volunteers harmless from any and all liability, actions, causes of actions, debts, claims or demands of every kind and nature whatsoever which may arise from such risks and for any injuries suffered by my child while participating in any 5PW practices, tournaments or other sponsored events. The terms hereof shall serve as a release of my heirs, estate, executor, administrator, assignees, and for all members of my family.

I, on behalf of myself, my spouse and my child, agree that the 5PW shall not in any way be held liable for any accident or injury in any way sustained by my child on account of or while engaged in any athletic activity conducted or sponsored by the 5PW. I further agree that neither the 5PW nor any of its directors, officers, or members shall be responsible for the payment of any bills rendered for medical services required by my child as a result of such accidents or injuries. I understand that I am fully responsible for any and all costs regarding medical attention and treatment to my child. I hereby give my consent for medical treatment deemed necessary by medical personnel designated by 5PW coaches or officers and/or for transportation to a hospital emergency room for treatment for any illness or injury resulting from my child's athletic participation.

In addition to giving my consent for my child to participate in 5PW practices and tournaments, I do, on behalf of myself and my spouse and my child, hereby waive, release and hold harmless the 5PW and its directors, officers, coaches and members for any injury that may be suffered by my child in the transportation to and from practice and tournaments.

I also acknowledge that it is my responsibility to provide for any medical disability or other insurance to mitigate any costs that may be unfortunately incurred as a result of my child's participation in these activities.

The provisions of this Consent and Release shall be governed by, and construed and enforced in accordance with, the laws of the State of New York and the State of California without regard to principles of conflicts of law. Any litigation arising hereunder or relating hereto or with respect to any injury sustained by my child shall only be brought in the courts of the State of New York in Nassau County or courts of the State of California in Los Angeles. I, on behalf of myself, my spouse and my child, hereby consent to the exclusive jurisdiction and venue of such courts. If any provisions of this Consent and Release shall be unenforceable or invalid, the same shall not affect the remaining provisions of this Consent and Release and to this end the provisions of this agreement are intended to be and shall be severable. I, on behalf of myself, my spouse and my child, do hereby expressly waive trial by jury in any litigation arising out of, connected with, or relating to this Consent and Release or any injury sustained by my child. I agree that the rule of construction to the effect that any ambiguities are to be resolved against the drafting party shall not be employed in the interpretation of this document. Neither this Consent and Release nor any provision hereof may be waived, modified, amended, discharged or terminated except by an instrument signed by the undersigned and an officer of the 5 Points Wrestling Club.

By clicking below, I certify that I have read the above, understand its contents, and agree to its terms.