Wrestling Registration Form

951 Wrestling Club Registration
Athlete Information
Athlete's Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Athlete's Name

First NameLast Name
Birth Date

MonthDayYear
Grade
Athlete's Name

First NameLast Name
Birth Date

MonthDayYear
Grade

Parent/Guardian Information
Name*

First NameLast Name
Cell Number*
E-mail*
example@example.com
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship
Phone Number*
Alt. Phone Number
Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature*
Name*

First NameLast Name

Payment Policy - Our memberships are paid monthly and require an automatic credit card payment. Once enrolled, we require a minimum 7-day written cancellation notice sent to 951wrestlingclub@gmail.com, we will cancel your future payments upon receipt. If your wrestler becomes injured or needs a break, we will pause your membership, please email 951wrestlingclub@gmail.com.

Wrestling Club - Individual

$80.00 one-time payment

Wrestling Club - Two Athletes

$140.00 one-time payment

Wrestling Club - Three Athletes

$200.00 one-time payment

Credit Card

Should be Empty:

951 Wrestling Club Registration

Credit Card