Team Jordan Club Registration | Jordan Trained

Team Jordan Club Registration

Step 1 of 5

Team Jordan Club*
Price:
*Step 1: Enter Wrestler Information
Name*
First Last
Age*
Please enter a number from 1 to 99.
Current Weight*
Please enter a number from 1 to 300.
Current Year in School*
School Attending*
Mailing address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
#1 Parent/Guardian name*
Phone Number*
Email address (confirmations & info about camp will be sent to this email)*
Enter Email Confirm Email
T-Shirt Size (Youth-Adult)*

Wrestler’s Name*
First Last
Parent Consent and Waiver of Responsibility
In consideration of Jeff Jordan’s State Champ Camp, LLC, acceptance of the Camper named above as a student in the camp for the periods described above, the Camper by and through his parent or legal guardian hereby acknowledges, understands and agrees to as following: Wrestling is a sport, which involves intense physical contact between two Individuals. The Camper will be involved in some intense training and competition including competitive wrestling. Injuries can and do occur during wrestling. As parent(s) or legal guardian(s), we’ve also been informed that various skin conditions are preventable in the sport of wrestling and while strong measures will be taken to prevent the spread of skin conditions such as Ring Worm, Herpes, and Cold Sores, 100% prevention cannot be guaranteed. Further, we the parent(s) or legal guardian(s) have been informed that there is an assumption of risk when anyone participates in the sport of wrestling. The understanding on behalf of themselves and their child or ward agrees to hold harmless Jeff Jordan’s State Champ Camp, LLC., its owners, staff, property owners and coaches (“Releasees”) from and against any injuries incurred by the Camper. The understanding hereby releases, waives, and forever discharges Releasees from and against any and all claims, injuries, demands, actions, or cause of actions arising out of the participation by the Camper in Jeff Jordan’s State Champ Camp, LLC. The understanding hereby certifies that the Camper is physically able to participate at the camp and that there are no impairments that would limit the participation in the programs. The understanding hereby grants permission for doctors and their designs to administer appropriate medical care, antigens, or injuries, and to perform emergency procedures as necessary.
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I will indemnify, save, and hold harmless Releasees from any and all losses. claims, actions, or proceedings of every kind and character, including related attorney's fees and expenses, which may be presented or initiated by any other persons or organizations and which arise directly or indirectly from my participation in the Activities, whether resulting from the negligence and/or other fault either active or passive of any of Releasees or from any other cause.
Medical Information
Insurance Company
Policy/Group #
ID#
Medical history that the Camp Staff should be aware of. (Example: Allergies, Concussion, ETC.)
Parent/Guardian:*
First Last
Phone - Home
Phone - Cell*
Parent/Guardian:
First Last
Phone - Home
Phone - Cell
RELEASE FOR USE OF PHOTO, VIDEO AND/OR LIKENESS
Photo Release*
The undersigned acknowledges that Jeff Jordan’s State Champ Camp, LLC (the “Camp”) may make videos, take pictures, utilize audiotape and any other image and sound based media for the purpose of recording drilling and active wrestling sessions and general activity at the Camp. The undersigned hereby freely and voluntarily consents to the use and publication of the undersigned’s name, participation, picture, and/or likeness by Jeff Jordan’s State Champ Camp, LLC for any and all purposes including, but not limited to, educational, promotional, advertising, and trade, through any medium or format, including, but not limited to, videotape, audiotape, film, photograph, television, radio, digital, internet, theater, or exhibition, at any time from this date forward until I revoke this consent in writing. I further waive any claims against Jeff Jordan’s State Champ Camp, LLC based upon or related to the use or publication of my likeness, voice, participation, and/or picture.
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I freely give this authorization without expectation of compensation.
INSPECTION WAIVER, RELEASE AND CONSENT
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The undersigned consents to Jeff Jordan’s State Champ Camp, LLC inspecting any and all gym bags, backpacks, luggage, suitcases or any other baggage (the “Baggage”) of any type brought by or maintained by the undersigned and/or the camp participant at any time and for any reason. Such release and waiver does not apply to the frisking of the camp participant’s person. The undersigned hereby releases, waives and forever discharges Jeff Jordan’s State Champ Camp, LLC from and against any and all claims, injuries, demands, actions or causes of action arising out of the searching or inspection of any Baggage belonging to the camp participant or anyone else in possession of the camp participant’s Baggage.
ACKNOWLEDGEMENTS
I agree that should one or more provisions in this Agreement be determined to be unenforceable by an arbitrator or a court, the remaining provisions shall continue to be binding and enforceable against me.

I agree and acknowledge that the terms and conditions of this Agreement shall continue in full force and effect now and in the future at all times during which I participate, either directly or indirectly. in the Activities, and shall be binding upon my heirs, executors, administrators, personal representatives. and/or anyone else claiming on my behalf. This Agreement supersedes and replaces any prior such agreement in favor of Releasees that I have signed.

I hereby acknowledge that I have read all of the provisions above and fully understand the terms and conditions expressed therein and agree to be bound by such terms and conditions.
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By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here. you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.
Wrestler's Name*
Parent or Guardian*
Signature*
Date*
MM slash DD slash YYYY

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