In order for your child to participate in Beat the Streets you as parent or guardian must complete this Consent & Waiver form. 

Child's Name *
Child's Name
WAIVER: In consideration for my child being permitted to participate in Beat the Streets Providence activities, I hereby waive, release and discharge any and all claims for damages for personal injury, death, or property damage which I may have on behalf of my child or myself, or which may hereafter accrue to me, as a result of his/her participation in Beat the Streets Providence activities. This release is intended to discharge Beat the Streets Providence (its officers, employees, volunteers and agents) from any and all liability arising out of or connected in any way with my child’s participation in Beat the Streets Providence, even though that liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above. It is understood that this activity involves an element of risk and danger of accidents and knowing those risks I hereby assume those risks. It is further agreed that this waiver, release and assumption of risk is to be binding on my heirs an assigns. I agree to indemnify and to hold the above persons or entities free and harmless from any loss, liability, damage, cost, or expense which they may incur as a result of my child’s death or any injury or property damage that my child or I may cause or sustain while participating in Beat the Streets Providence activities. CONSENT: I hereby additionally consent that my child, may participate in all Beat the Streets Providence activities and I hereby execute this Agreement, Waiver, Release and Consent on his/her behalf. I state that I am the parent or guardian of the named child and that I have legal authority to enter into this waiver and release on his/her behalf. I also state that said child is physically able to participate in Beat the Streets Providence activities. Permission is hereby granted for my child to be transported by program staff and volunteers as well as to receive emergency medical treatment, if needed. I hereby agree to indemnify and hold the persons and entities mentioned above free and harmless from any loss, liability, damage, cost or expense which they may incur as a result of the death or any injury or property damage that said child may cause or sustain while participating in Beat the Streets Providence activities. I have carefully read this Agreement, Waiver, Release and Consent and fully understand its contents. I understand that this Agreement, Waiver, Release and Consent is intended to be as broad and inclusive as permitted by the laws of the State of Rhode Island and agree that if any portion of the agreement is invalid, that the remainder will continue in full legal force and effect. I am aware that this is a release of liability and a contract between myself and Beat the Streets Providence and I sign it of my free will on behalf of my child and myself.
Your Name *
Your Name
Date *
Date
Emergency Contact Information
This must be completed before a wrestler can participate in the Beat the Streets Program.
Wrestler's Birthdate *
Wrestler's Birthdate
Gender
Home Phone # *
Home Phone #
Parent/Guardian Name (1) *
Parent/Guardian Name (1)
Parent/Guardian Cell # (1) *
Parent/Guardian Cell # (1)
Parent/Guardian Work # (1)
Parent/Guardian Work # (1)
Parent/Guardian Name (2)
Parent/Guardian Name (2)
Parent/Guardian Cell # (2)
Parent/Guardian Cell # (2)
Parent/Guardian Work # (2)
Parent/Guardian Work # (2)
Family Doctor's Name *
Family Doctor's Name
Family Doctor's Phone # *
Family Doctor's Phone #
Emergency Contact (not parent/guardian) *
Emergency Contact (not parent/guardian)
Emergency Contact Cell # *
Emergency Contact Cell #
Emergency Contact Work #
Emergency Contact Work #
Optional Information
My child is eligible for free or reduced lunch