Last updated 6/5/13 Registration Form & Release of Liability 1

ARM WRESTLING TOURNAMENT

REGISTRATION & CONTACT FORM

Name: __________________________________________________________________

Date of Birth: _____________ Age: _____________

Weight Class:

Male Heavyweight: 211 lb + Female Division: Under Age 50

Male Middleweight: 176-210 lb Female Masters: Age 50+

Male Lightweight: ≥ 175 lb. Pro Division

Male Masters: Age 50+ Wrestle a Pro

Weight: _____________ (Men/Pros Only)

Address: ________________________________________________________

City: __________________________ State: ________ Zip: ______________

Phone: ______________________ Email: ____________________________

RELEASE OF LIABILITY AND INDEMNITY AGREEMENT

This form to be completed by persons 18 years of age or older.

(PLEASE READ CAREFULLY BEFORE SIGNING)

In consideration of being allowed to participate in any way in the CHINGAWASSA DAYS

ARM WRESTLING TOURNAMENT, sponsored by MARION WELLNESS CENTER, LLC

and LALOUETTE LAW, LLC, the undersigned acknowledges, appreciates, and agrees that:

1. The risk of injury from the activities involved in this event is significant, including the

potential for permanent disability and death, and while particular rules, equipment, and

personal discipline may reduce this risk, the risk of serious injury to me does exist.

2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and

unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES

or others, and assume full responsibility for my participation.

3. I willingly agree to comply with the stated and customary terms and conditions for

participation. If I observe any unusual significant concern in my readiness for

participation and/or in the event itself, I will remove myself from participation and bring

such to the attention of the nearest official immediately.

4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin,

HEREBY RELEASE MARION WELLNESS CENTER, LLC, LALOUETTE LAW,

LLC, THE CHINGAWASSA DAYS COMMITTEE, LORI LALOUETTE,

Initial

Last updated 6/5/13 Registration Form & Release of Liability 2

CHRISTIAN PEDERSON, TRAVIS BERGGREN, RANDY CRAWFORD, TRENT

BENTLEY, BRONSON SHIPMAN, EVAN STOUT, SARA JANE MILLER and

any persons helping, officiating, or assisting in any way at the tournament, their

officers, officials, agents, and/or employers, other participants, sponsoring agencies,

sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct

the event (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY,

DEATH or loss or damage to person or property incident to my involvement or

participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF

THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

5. The terms of this Release of Liability are to be governed by and construed under the laws

of the State of Kansas. In the event any term or provision of this Release of Liability is

found to be unenforceable or void, in whole or part, the term of provision concerned shall

be construed as valid and enforceable to the maximum extent permitted by law, and the

balance of this Release of Liability shall remain in full force and effect.

6. I agree that exclusive venue for any dispute arising between the Releasees and I involving

this Release of Liability in any way is Marion County, Kansas.

ACCEPTED AND AGREED:

I have read this waiver of liability and indemnification agreement and fully understand its

terms. I understand that I am giving up substantial rights, including my right to sue. I

acknowledge that I am signing the agreement freely and voluntarily, and intend my

signature to be a complete and unconditional release of all liability to the greatest extent

allowed by the law in the State of Kansas.

By: ___________________________________ Date: _______________________

(SIGNATURE)

____________________________________

(PRINTED NAME)

If participant is under 18:

As legal guardian of ________________________________, I execute this release of liability

and consent to above terms and conditions.

By: ___________________________________ Date: _______________________

(SIGNATURE)

____________________________________

(PRINTED NAME)

RULES

Weight classes and Masters Division subject to change based on

participants’ weights and ages.

At sign in, you may choose to compete in your weight class or one weight

class higher.

Once signed into a weight class, it’s FINAL.

Matches are determined by bracket assignments assigned by day of birth

(day only in ascending order; lose two times before out).

Double elimination – NEW! (Winner & Loser brackets with loser getting

chance to get back into finals)

1st, 2nd, & 3rd place prizes will be given.

Referee’s decision is final at all times.

Poor sportsmanship is an immediate disqualification.

FOULS

2 fouls and you are disqualified.

Lifting elbow off table.

Taking hand off peg.

Intentional delay – beyond 60 second allowance to get grip

Using any part of body to pin opponent.

Slip of grip while losing – 60/40

False start

o 1st = Warning ▪ 2nd = Foul ▪ 2 Fouls= DQ

Using legs to gain leverage against table

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