2019 coaches clinic signup page

Thank you for your payment. Please submit the following form to secure your spot on the roster.

First Name *

Last Name: *

E-mail Address: *

School: *

Street address: (where to mail info to you)

City *

State

Zip Code

Comments

I agree to hold harmless Randy Simpson, staff, and property owners, from and against any injuries sustained by the participant. The understanding hereby releases, waives, and forever discharges Randy Simpson and Randy’s Attack System Wrestling, LLC, from and against any and all claims, injuries, demands, actions, or cause of actions arising out of the participation by the attendee in Randy’s Attack System Programs. I understand that payment arrangement is due before attending sessions. We do not Pro-rate for missed sessions.

Video release: I hereby grant permission to Randy’s Attack System Wrestling, LLC, the rights of my image, in video or still, and of the likeness and sound of my voice as recorded on audio or video without payment or any other consideration. I understand that my image may be edited, copies, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my child’s likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I also understand that this material may be used in diverse educational settings within an unrestricted geographic area.

Name of person agreeing to the above

* Required