Golden Eagles Wrestling Club

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PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

State:

Zip Code:

Home Phone:

* Birthdate:

Email:

* Short size:

* T Shirt size:

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 #:

I/we agree with the above and have or will send GEWC all required information for IKWF/USA Wrestling registration. *

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