CRESTVIEW WRESTLING CLUB

CRESTVIEW WRESTLING CLUB
2021-2022 SIGN UP
ATHLETE INFORMATION
NAME*
BIRTHDAY*
MonthDayYear
GENDER*
ADDRESS*
PARENT/GUARDIAN 1 NAME*
PHONE NUMBER*
RELATIONSHIP TO ATHLETE*
EMAIL
EMERGENCY CONTACT*
PHONE NUMBER*
HAS YOUR ATHLETE WRESTLED IN THE PAST
YESNO
IF YES, PLEASE LIST EXPERIENCE BELOW (YEAR/SCHOOL/TEAM/STYLE)
PLEASE UPLOAD A COPY OF BIRTH CERTIFICATE
Cancelof
MEDICAL INFORMATION
INSURANCE PROVIDER & POLICY NO.*
DOES YOUR ATHLETE HAVE A CURRENT PHYSICAL?*
YESNO
PLEASE UPLOAD A COPY OF PHYSICAL
Cancelof
DOES YOUR ATHLETE HAVE ANY ALLERGIES OR MEDICAL CONDITIONS?*
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 Crestview 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 Crestview 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*
Clear
*
PAYMENT
PAYMENT TYPE
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