DC TAKEDOWN CLUB
Youth Wrestling Information Form
STUDENT-ATHLETE NAME
*
First Name
Last Name
USA WRESTLING CARD #
(IF APPLICABLE)
DATE OF BIRTH
*
-
Month
-
Day
Year
PARENT/GUARDIAN 1 NAME
*
First Name
Last Name
PARENT/GUARDIAN 2 NAME
First Name
Last Name
PRIMARY EMAIL 1
*
example@example.com
PRIMARY EMAIL 2
example@example.com
PRIMARY PHONE NUMBER
*
-
Area Code
Phone Number
MAILING ADDRESS
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PLEASE CHECK ALL THAT APPLY
*
WE ARE INTERESTED IN RECEIVING INFORMATION REGARDING CAMPS, CLINICS, AND WRESTLING COMPETITIONS
Submit
Should be Empty: