Before you submit this form…

Be sure to read the Health Protocols here that every athlete and family will abide by.

Submit the following form to get on the Priority List for training. Once your group is formed, you will be emailed with a link to complete payment.

First Name (Athlete) *

Last Name: *

E-mail Address: *

To increase your chances of getting selected for a group, be sure to Select all training times that you are available to train *

Monday Late Afternoon (3:30 - 5:30 arrival time)
Monday Evening (7 pm - 8 pm arrival time
WednesdayLate Afternoon (3:30 - 5:30 arrival time)
Wednesday Evening (7 pm - 8 pm arrival time )

Street Address: *

Address Line 2:

City: *

State: *

Zip *

School *

Phone Number: *

Graduation Year (LAST 2 digits) *

Date of Birth (MM/DD/YYYY) * / /

Weight *

Years of wrestling experience *

Accomplishments *

My greatest attributes as a wrestler are::

My biggest weaknesses as a wrestler are:

Name a few partners you would feel would be a good fit here, in your group or other groups

Commenta, questions, suggestions for group names, etc

For the health safety and well-being of myself, as well as other wrestlers, I have read and agree to abide by all aspects of this training's Health protocol, as outlined on the page. *

I agree to hold harmless Randy Simpson, staff, and property owners, from and against any injuries sustained by the participant, including illness such as Covid-19. 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 athlete in Randy’s Attack System Programs. I authorize the program director and/or staff to act in my behalf regarding any situation requiring discipline or medical attention. My son is physically fit to participate in this program, according to his family doctor. I understand that payment arrangement is due before attending sessions. We do not Pro-rate for missed sessions. *

Injury Policy: We don't offer refunds for folks who just plain don't show up. However, If your athlete cannot attend this training due to a medical issue, prior to the start of training, a CREDIT may be applied for future training, minus a small processing fee of $25. * **No Refunds once the training has begun**. *

Video release: I hereby grant permission to Randy’s Attack System Wrestling, LLC, the rights of my child’s image, in video or still, and of the likeness and sound of their voice as recorded on audio or video without payment or any other consideration. I understand that my child’s 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 child’s image or recording. I also understand that this material may be used in diverse educational settings within an unrestricted geographic area.

Name of Parent/Guardian agreeing to the above *

* Required