FS / GR Registration

Coulee Region Wrestling

Provided by Holmen Viking Wrestling Club

Coulee Region Wrestling is provided by the Holmen Viking Wresting Club. The goal is to provide both boy and girl wrestlers in the Coulee Region with the opportunity to train Freestyle and Greco wrestling. Open to wrestlers of all experience levels from 5th to 12th grade. Sessions will be at Holmen High School – 1001 McHugh Rd, Holmen, WI.

Both boys and girls will run together on Mondays and girls only on Wednesdays.

Athlete Info
Name*
Athlete First Athlete Last
Date of Birth*
MM slash DD slash YYYY
USA Card Number*
School Attended by Athlete*
Grade Level*
Parent Guardian Info
Primary Parent Gaurdian*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone*
Secondary Parent Gaurdian (if needed)
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Phone
Medical Information
Insurance Company*
Insurance Policy Number*
Family Doctor*
Is your child on any medications*
- Yes
- No
Please list the medications*
Does your child have any drug sensitivities or food allergies?*
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- No
Please List*
Medical Treatment (please check just one)*
Please read the alternative statements below and select the statement you prefer for your son or daughter.
- If my child needs medical attention, it is my wish that I am contacted before any medical procedures are taken on my child, unless immediate treatment is necessary to save my child’s life or to prevent permanent injury.
- If my child needs medical treatment while participating, it is my wish that the treatment is started while efforts are being made to contact me. So that treatment is not delayed, I consent to any medical procedures that the physician believes are needed, on the understanding that efforts to contact me will continue to be made. I accept responsibility for all costs to such treatment.
Athlete Registration*
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FS / GR Registration

Athlete Info

Parent Guardian Info

Medical Information