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DC Elite - Hiawatha:  Registration Form
Please fill out completely in order to Participate in DC Elite Wrestling Practices
Email *
Developing Champions Since 2006
Athlete First Name *
Athlete Last Name *
Athlete's Current School *
Athlete's Current Grade in School *
Athlete's Current Weight *
Anticipated Level of Practice (Sept - March)

True Beginner - Tues/Thurs 5:30pm
Novice - Tues/Thurs 6:30pm
Advanced & HS Boys/Girls - Sun 4pm, Mon/Wed 6:30pm
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Payment schedule - due 1st week each month

Drop in rate $25/practice per kid - max of 2 times/month
Beginner:  $100/m
Novice:  $135/m
Advanced Boys/Girls:   $165/m
High School:  $135/m
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Waiver - Please Sign Legal Guardian's Name Acknowledging Consent to Participate and Release of Liability to DC Elite Wrestling

Legal custodian:  By signing below I give my full consent and permission for Athlete named above to participate in practices and all activities associated with DC Elite Wrestling Club.  I agree to hold harmless and indemnify the Club, Coaches, and Facility located at 913 Metzger Dr in Hiawatha, IA from any and all liabilities, damages, loss, or expenses that may be sustained during the course of any DC Elite event.  I also give consent, if an emergency should arise, for members of DC Elite to begin necessary medical treatment while attempting to contact myself or others listed on this consent form as “Parent” and “Emergency Contact”.  
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Primary Contact's Name (Write First & Last)
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Primary Contact Cell
 *
Primary Contact Email
(an invitation to TEAMSNAP will be sent to this email and used for team communication;  this profile may add additional email addresses on TEAMSNAP)
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Secondary Contact Name (Write First & Last Name) *
Secondary Contact Cell *
Secondary Contact Email *
USA # for Athlete Named Above (Must have USA or AAU card)

AAU # for Athlete Named Above (Must have USA or AAU card)

Anticipated planned 1st Practice
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Please write a little about your child's experience thus far, concerns, or further questions.

We're looking forward to helping your athlete experience the joys of wrestling, build confidence, grow physically & mentally, and enjoy the journey and friendships wrestling offers. Thank You!

Feel free to contact Mindy Washburn at:
cell - 319-270-2057
email - mindywashburn@yahoo.com

or Dustin Coufal at:
cell - 319-350-0274
email - dustin.coufal@yahoo.com
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