Signups

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Wrestler’s Name:

Wrestler’s Date of Birth:

Wrestler’s Home Address:

Wrestler’s School:

*If other, please list school attending:

Wrestler’s Grade:

Teacher’s Name:

Wrestler’s T-Shirt Size:

Does the Wrestler have previous wrestling experience?

*If Yes, how many previous years have they wrestled?

Does the Wrestler have any medical conditions or allergies coaches should be aware about?

If Yes, please list:

Parent’s Name:

Parent’s Address:

Parent’s Phone Number:

Parent’s Email Address:

Emergency Contact if Parent(s) are unavailable:

Emergency Contact’s Phone Number:

Legal Release: I the parent / legal guardian of the above named wrestler give my permission for my child to participate in the Penn Manor Youth Wrestling Club and all activities associated with the wrestling program. I, as the legal custodial parent / guardian of the above named wrestler, assume all risks and hazards incidental to such participation. I do hereby release, resolve, indemnify and agree to hold the Penn Manor Youth Wrestling Club and Penn Manor School District, its officers, coaches, and parties or persons involved from any claims arising from injury. We also understand the Penn Manor Youth Wrestling Club and Penn Manor School District does not carry primary accidental or liability coverage for their participants. I, the undersigned, understand it is my personal responsibility to provide primary insurance coverage for my child.

I Agree.

Please type your name to signify all information on this form is correct and that you agree to the above listed release.

Penn Manor Youth Wrestling Club