Wrestler's First and Last Name *

Wrestler's Date of Birth *

Preferred Email to Receive ALL Club Communication (Please double check this section is correct!) *

Additional Email to Receive ALL Club Communication (Please double check this section is correct!) *

Home Address (including City, State, Zip Code) *

Parent/Guardian Name and Phone Number (multiple if preferred) *

School *

Grade *

Approximate Weight *

Approximate Height *

T-Shirt Size *

Experience Level *

Is there any medical information that you feel we need to be aware of? (allergies, physical restrictions, general concerns, etc) *

Emergency Contact (Name and Number) *