JUST A GIRL CLINIC

2025 JUST A GIRL CLINIC REGISTRATION/WAVIER

PLEASE READ: Please fill out the following registration waiver for the 2025 Just a Girl Clinic with Marisol Nugent. Payment must be received within one week of registration in order to hold your spot. Space is limited so please do not wait.

* Indicates required field

Parent or Gaurdian *

First

Last

Email *

Address *

City *

State *

Zip *

Primary Phone *

Secondary Phone *

Participant Name *

First

Last

Birthdate *

Grade *

Weight *

Shirt Size *

Special needs/allergies *

Please Choose a Session: *

High School - Session - July 21/22 - $120 Youth Session - July 23/24 - $110

Payment Options *

Venmo Check

Venmo payments :
@Wayne-Moda (6225)

Check payments can be mailed to:
Wayne Moda
Red Roots Wrestling Club
15 Tibbetts Ave.
Danvers, MA 01923

Emergency Contact *

First

Last

Emergency Contact Phone *

Release *

I agree

I do hereby consent to participation in the Red Roots Wrestling Club Just a Girl Clinic Camp and do forever release, acquit, discharge and covenant to hold harmless the Red Roots and its successors, agents, servants and officers from any and all actions, causes of action, and claims, demands, damages, costs, on account of, or in any way growing out of, directly or indirectly, all known and unknown personal injuries or property damage which I/we may have now or hereafter have as the parent or guardian of said minor and also all claims or right of action for damages which said minor has or hereafter may acquire, either before or after reaching majority resulting from her/his participation of the Red Roots Wrestling Camp and/or receiving medical attention as provided herein; furthermore, I/we hereby agree to indemnify, reimburse or make good to the Red Roots Wrestling Club and/or its successors, agents, servants and officers any loss or damage or costs, including attorney’s fees, the Club or its representatives may incur if any litigation arises from said minor’s intentional, grossly negligent, or reckless acts or omissions while participating in said recreation programs. I/We understand that this program involves physical activity and hereby state that to my/our knowledge such minor is in proper physical condition for participation in such programs. I/We also agree to provide such minor with all the proper and required equipment to participate in such programs.

In the event of an emergency requiring medical attention, beyond first aid, I/we hereby grant permission to a physician or hospital personnel designated by the Red Roots Wrestling Club to attend to such minor. I have fully read and understand the terms of this release and waiver.

Electronic Signature *

Submit

Click the "SUBMIT" button to complete the registration process and pay for your order.