2009 Club Simpson Elite - Randy's Wrestling Site

Club Simpson-Elite Registration FormName ________________________________ Grade: ________ Date of Birth: ____________School: __________________________Address: ______________________________City, State, Zip: ________________________________________Phone: ______________________________ Height: ________ Weight:__________Email:____________________________________Name of parent/guardian: __________________________________Insurance Policy: ___________________________________________________________Accomplishments: ___________________________________________________________I hereby release Randy Simpson and his family from liability in the event of injury or death, and I authorizehim to act in my behalf regarding any situation requiring discipline or medical attention. My son isphysically fit to participate in personal training, according to his family doctor. I understand no refundsare available.________________________________ ___________________________Signature of parent/guardian: Date:For more information, call Randy: (614)-861-6964 or Email: Randy@randyswrestlingsite.comNote #1: I will only take around 12-15 athletes for each group, and we will have 2groups. Each athlete is expected to atttend all sessions, barring unforeseen circumstances.No substitutions, replacements or refunds.Note #2: All athletes will undergo a thorough skin inspection before every session.Skin infections are responsible for more downtime in wrestling than anyother injury, and can cause serious health problems. We take every precautionto keep all athletes safe and healthy.Note #3: All Athletes - Check the Club Simpson page on our website for furtherdetails and updates.www.randyswrestlingsite.com/clubsimpson.htmlIf interested, contact me or mail in the form with check or money order to: RandySimpson, Box 1234, Reynoldsburg, OH 43068. If not selected, your check will be returnedto you. You will be contacted one way or another. NO REFUNDS OR DISCOUNTS www.randyswrestlingsite.com