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Bethel Allstars Wrestling Freestyle/Greco Registration
**Please complete one form per wrestler**

Cost per wrestler for Freestyle/Greco Season $50.00
*****USA Card Required*****

*
USA Card Number *
Your answer
FIRST NAME *
Your answer
LAST NAME *
Your answer
DATE OF BIRTH *
MM
/
DD
/
YYYY
GRADE
Your answer
ADDRESS
CITY/STATE/ZIP *
Your answer
PARENT / GUARDIAN INFORMATION #1
PARENT/ GUARDIAN NAME *
Your answer
CONTACT NUMBER *
Your answer
EMAIL *
Your answer
PARENT/GUARDIAN INFORMATION #2
PARENT/ GUARDIAN NAME
Your answer
CONTACT NUMBER
Your answer
EMAIL
Your answer
EMERGENCY CONTACT ( OTHER THAN PARENT
NAME *
Your answer
PHONE NUMBER *
Your answer
DOCTORS NAME
Your answer
PHONE NUMBER
Your answer
ALLERGIES? *
Your answer
DRUG SENSITIVITES: *
DESCRIBE IF YES
Your answer
Is child presently on medication?
List Medication
Your answer
Preferred Hospital
Your answer
Name of Insurance/group number *
Your answer
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