I90 Individual - 2027

Name

Date of Birth

Gender

Male
Female

Age

Choose the Open or Girls Division

Open Division

Open Division Weight Class

Girls K-8 (Freestyle)

Girls Highschool (Freestyle)

Team / Club Name

Parents Name

Entry Fee

I90 Individual 2027 ($50.00)

Waiver*

In consideration of my application and permitting the child I signed up to participate in this event, I hereby take action for this child, myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) Waive, release, and discharge from any and all liability for my death, disability personal injury, property damage, property theft or actions of any kind which may hereafter accrue to me or my traveling to and from this event, THE FOLLOWING ENTITIES OR PERSONS: PRIMA, (INSERT OTHER INVOLVED ENTITIES), and their directors, officers, employees, volunteers, representatives and agents, the event sponsors and event volunteers, (B) indemnify and hold harmless all entities or persons mentioned in this paragraph from any and all liabilities or claims made by other individuals or entities as a result of my actions during this event.

Phone Number

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Running Total

$50.00

Convenience Fee

$5.00

Total

$55.00

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Address

Mobile Phone Number

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