951 Wrestling Club

951 WRESTLING CLUB
ATHLETE INFORMATION
NAME*
BIRTHDAY*

MonthDayYear
GENDER*
ADDRESS*
PARENT/GUARDIAN 1 NAME*
PHONE NUMBER*
Format: (000) 000-0000.
RELATIONSHIP TO ATHLETE*
EMAIL*
example@example.com
EMERGENCY CONTACT*
PHONE NUMBER*
Format: (000) 000-0000.
YESNO
IF YES, PLEASE LIST EXPERIENCE BELOW (YEAR/SCHOOL/TEAM/STYLE)
MEDICAL INFORMATION
YESNO
IF YES, PLEASE LIST BELOW
LEGAL DISCLAIMER
I PARENT/LEGAL GUARDIAN* , the parent/legal guardian of ATHLETE* agree and make public that I will not hold 951 Wrestling Club, coaches, its staff, volunteers, and affiliates, or any other participants responsible for any accidents or injuries that may be sustained in connecting with 951 Wrestling Club. I understand precautions for safety have been taken. I also understand accidents do happen and I assume responsibility for any losses thereof. I also authorize emergency treatment if it should become necessary and do hereby give my consent for any medical treatment deemed necessary.
Signature*
Date*
PAYMENT

PRODUCTS*

Monthly Wrestling Club Membership

Payment Policy - Our memberships are paid monthly and require an automatic credit card payment. If your wrestler becomes injured or needs a break, or would like to cancel, please email 951wrestlingclub@gmail.com.

$120.00 for each month

CREDIT CARD

Should be Empty:

951 WRESTLING CLUB

ATHLETE INFORMATION

MEDICAL INFORMATION

LEGAL DISCLAIMER

PAYMENT

CREDIT CARD