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Complete the following entry form in order to start the registration process. If you have more than one athlete, please submit separate forms for each. Contact me if you encounter any issues.

Submit your Entry Form here to secure your spot

Name *

First

Last

Date of Birth *

Graduation Year (4 digits) *

Email *

Street Address *

City, State, Zip *

Phone Number *

School *

Weight

Commitment Level

Bronze Level (February-only, High School/Junior High)

Which Group

HS/Junior High

Accomplishments / experience level *

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, illnesses (including Covid-19), 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, however, bonus sessions are offered each month so hey - Lots O' Mat Time! *

The following is a requirement for participation

I have read and agree that my child will follow all health protocols set forth and described on the associated web page for this program.

Injury Policy: We don't offer refunds for folks who just plain don't show up. However, If your athlete suffers a medical condition that prevents him from participating in any of the sessions, and you include documentation from a doctor at least a week prior to the start of small group training, a CREDIT may be applied for future training, minus a small processing fee of $25. *

requirement for participation

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. *

Requirement for participation

Name of Parent/Guardian agreeing to the above *