Nate Tomasello Clinic – Barn Brothers Wrestling

NATE TOMASELLO

4x ALL-AMERICAN

Walt Whitman HS

Sunday, December 7th

9am-11am for Beginners

12-3pm Advanced

Athlete's Name

Weight

School

Allergies or Medications

Parent / Guardian Name

Parent / Guardian Phone

Emeregency Contact

Waiver

Acknowledgment of Risk: I, the undersigned parent/guardian of the above-named participant (or the participant if 18 years or older), acknowledge that wrestling, training, camps, and clinics involve inherent physical risks, including but not limited to sprains, strains, concussions, communicable diseases, or in rare cases, permanent disability or death. I voluntarily assume all risks. Medical Authorization: In the event of injury or illness, I authorize B2 Wrestling Corp / Barn Brothers Wrestling Club staff to obtain medical treatment deemed n including emergency transportation, and I accept responsibility for any associated costs. Release of Liability: In consideration of participation, I release and hold harmless B2 Wrestling Corp, Barn Brothers Wrestling Club, their coaches, staff, property owners, landlords, USA Wrestling, sponsors, insurance providers, and affiliates from any and all liability arising from participation, to the fullest extent permitted by law. Indemnification: I agree to indemnify and hold harmless the above-listed parties against any claims, damages, or expenses resulting from participation. Medical Certification: I certify the participant is physically fit and has valid insurance coverage. I will update the club with any medical changes. Photo/Video Release (Optional): I grant permission for B2 Wrestling Corp / Barn Brothers Wrestling Club to use photos/videos of the participant for promotional purposes I agree to the Photo/Video Release

Signature