Wrestler Registration Form

Wrestler's Name

Wrestler's Grade

Wrestler's DOB

Wrestler's Weight

Wrestler's School

Wrestler's Zoned High School

Wrestler's Experience

Wrestler's USAW Card #

Wrestler's Email

Wrestler's Cell

Wrestler Info

Parent/Guardian 1 Name

Parent/Guardian 1 Cell

Parent/Guardian 1 Email

Parent/Guardian 2 Name

Parent/Guardian 2 Cell

Parent/Guardian 2 Email

Emergency Contact (not in home)

Emergency Contact Cell

Insurance Company

Insurace Policy Number

Person Responsible for Charges

Wrestler's Medical Provider

Medical Provider's Address

Medical Provider Phone

Wrestler's Allergies and/or Medical Contition

Medications

Date of Tetanus Booster

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