Youth Registration

Youth Wrestling Registration 2021 (1st - 8th Only)

Athlete Info
Name*
Athlete First Athlete Last
Date of Birth*
Date Format: MM slash DD slash YYYY
USA Card Number
School Attended by Athlete*
Grade Level*
T-shirt Size*
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?*
- Yes
- No
Please List*
Approximate Date of last physical exam by a doctor*
Date Format: MM slash DD slash YYYY
Medical Treatment*
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.

Youth Registration

Youth Wrestling Registration 2021 (1st - 8th Only)

Athlete Info

Parent Guardian Info

Medical Information