NAME__________________________________________Birthdate________________

Years
Wrestled____________Wins/Losses____________Grade________CLUB____________

Parents Name:_______________________Phone_______________________

Liability Waiver:  In consideration of you accepting this entry, I hereby for myself, my heirs, my executors, and administrators, waive and release any and all injuries suffered by me at or in connection with the 2009 Scribner-Snyder Youth Wrestling Tournament, Scribner-Snyder Youth Wrestling Club and Scribner-Snyder Community Schools.

Parent/Guardian Signature ____________________________Date________________