SIGN-UP

RACINE YOUTH SPORTS (RYS) JUDO, INC.

RACINE, WISCONSIN

YOUTH JUDO LEAGUE WAIVER FORM

BEFORE SIGNING THIS WAIVER, PLEASE READ CAREFULLY!!!

I, the undersigned parent or guardian waive all rights to hold RYS, it's instructors, coaches, officials, officers and the Board of Directors responsible for any injury of my child/children during these training sessions.

I also understand that an enrollment fee covering ten weeks of Judo instruction will be charged to my child which is payable at the time of registration, in order to be eligible for the Judo session. 1, the undersigned parent or guardian agrees that once my child is placed on the roster and begins practice, but then decides to quit, the enrollment fee is forfeited to the association.

To the best of my knowledge, my child is free from any contagious disease or physical/mental defect.  My child is physically fit to participate in a physical education program.  I understand that the RYS Association is in no way liable for illness or injury resulting from physical unfitness of my child, and that RYS RESERVES THE RIGHT TO REQUIRE A MEDICAL EXAMINATION PRIOR TO ACCEPTING A REGISTRATION.

I CERTIFY THAT I AM THE LEGAL PARENT OR GUARDIAN OF SAID CHILD.
 

Child's Full Name                      ______________________________________

Signature of Parent or Guardian ________________________________

Date                 /          

Address            _________________________________      Zip Code  ____________

Phone Number __________________________________

                             (Must be 8 years old)

Child's Date of Birth                              Name of Family Physician  _____________________

Insurance Company _____________________ 

 Parent or Guardian Place of Employment & City _____________________________________

 LEAGUE OF PLAY

PLEASE CHECK ONE                        Beginner   ______          Advance   _______

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