2024 Wrestling Registration Form

Piper Kids Wrestling Club Registration

2025-2026 season
Athlete Information
Wrestler Name

First NameLast Name
Birth Date

MonthDayYear
Shirt size
Current Weight
Wrestling experience
Parent/Guardian Information
Name

First NameLast Name
Phone Number

Area CodePhone Number
Alt. Phone Number

Area CodePhone Number
E-mail
Alt. E-mail
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Payments Due by Nov. 10, 2025
prevnext( X )
Check$150.00
Payable to Rodney Gibson

Venmo$150.00
@Rodney-Gibson-13

Pay Pal$150.00
@RodneyGibson

Cash$150.00

Total $0.00
The registration fee includes:

- USA MEMBERSHIP CARD

- INSURANCE

- CLUB T-SHIRT
Piper Kids Wrestling club will take pictures throughout the season. We use these photos to promote and celebrate our proud Piper Pirates. Do you agree to the use of photos of your wrestler on the Piper Kids Wrestling club social media pages?
Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by Piper Kids Wrestling club. In exchange for the acceptance of said child’s candidacy by Piper Kids Wrestling club, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Piper Kids Wrestling club, and all its respective coaches, clinicians, USD 203 Piper school district and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from all club activities. In case of injury to said child, I hereby waive all claims against Piper Kids Wrestling club, including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including wrestling.
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
Should be Empty:

Piper Kids Wrestling Club Registration

Payments Due by Nov. 10, 2025*

Payments Due by Nov. 10, 2025