Address __________________________________ Zip _____________

Phone _______________________________________

Birth Date _________________________________

School _________________________________

Approximate Weight ______________________

Release of Liability: For good and valuable consideration, including the undersigned's participation in the above event sponsored by the Brookville High School Mat Club and held at the Brookville Area High School in Brookville, PA, the undersigned participant, for herself, her successors, heirs, assigns, and executors, administrators, legal representatives, employers, agents and affiliates, forever releases and discharges the Brookville High School Mat Club and the school district, as well as their officers, directors, employees, agents, and affiliates from all claims, demands, losses, costs, expenses, suits, damages, obligations, liabilities, causes of actions, and judgments whatsoever, in law or in equity, which the participant has had or ever will have by reason of any matter, cause or thing whatsoever, arising out of participant's involvement in this event. Participant agrees to and does hereby assume any and all risks of personal injury (including but not limited to: sprains, fractures, paralysis.

Participant's Signature _________________________________

Date _______________

Parents/ Guardian Signature _________________________________

Date ______________

Tiffany Sarvey
103 Jenks Street
Brookville, PA 15825

All participants must sign the Release of Liability and must have the signature of a parent or guardian.

Any contestants who E-mail their entry forms will be required to have a parent or guardian sign the release form the day of the tournament before the competition begins.

There is no entry fee for this tournament, only admission fees.
Admission will be $2 for students and $3 for adults.

All entry forms are due one week before the tournament.

( Due April 21, 2001)

This tournament is a fundraiser for the Brookville High School Mat Club and is meant to be a fun event for the girls to participate in. The competition will be set up as a dual meet and all participants will have at least one match and possibly more depending upon the number of entries.

Please print this notice and post in your local schools.

District IX