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October Wrestling Wednesday Registration - October 2, 9, 16, 23, 30th - 6:00pm -7:30pm
PLAYER INFORMATION
*
First Name:
*
Last Name:
*
Street:
*
City:
State:
Zip Code:
Home Phone:
*
Birthdate:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
1
2
3
4
5
6
7
8
9
10
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25
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27
28
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30
31
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
Email:
*
Grade:
K
1
2
3
4
5
6
7
8
9
10
11
12
PARENT/GUARDIAN #1
Firstname:
Lastname:
EMail:
Home Phone:
Work Phone:
Cell Phone:
PARENT/GUARDIAN #2
Firstname:
Lastname:
Email:
Home Phone:
Work Phone:
Cell Phone:
MEDICAL/EMERGENCY CONTACT INFORMATION
Emergency Contact:
Phone:
Relationship to Player:
Insurance Carrier:
Policy #:
WAIVER INFORMATION
*** Insert your waiver information here ***
I/we agree with the above
*
test
* indicates required fields
SELECT FEE
$20 - 2024 October Wrestling Wednesdays
$10 - Additional wrestler
$10 - Additional Wrestler