River City Wrestling- Registration
Please use this form to provide information for registration. You will still need to sign the USA Medical Waiver and bring it to your first practice. This can be found at http://www.rivercitywrestling.org/rivercity-wrestling-forms.html
Which program are you registering for? (check calendar for dates/times) *
Required
Wrestler's Last Name *
Your answer
Wrestler's First Name *
Your answer
School *
Name of school your wrestler currently attends
Your answer
Shirt Size *
Grade *
Current Grade Level (for Summer Camps- list grade level entering next year)
Wrestler's Date of Birth *
Format dd/mm/yyyy (01/02/2001)
Your answer
Street Address *
ex. 1609 Poplar Level Road
Your answer
City *
ex. Louisville
Your answer
State *
ex. KY
Your answer
Zip Code *
ex. 40217
Your answer
Parent/Guardian-1 email address *
Your answer
Parent/Guardian-1 Name *
Your answer
Parent/Guardian-1 Relationship to Wrestler *
Your answer
Phone Number (parent/ guardian-1) *
ex. 502-123-4567
Your answer
Parent/Guardian-2 Name
Your answer
Parent/Guardian-2 email address
Your answer
Parent/Guardian-2 Relationship to Wrestler
Your answer
Phone Number (parent/ guardian-2)
ex. 502-123-4567
Your answer
Emergency Contact- Name *
Person to Contact if you cannot be reached
Your answer
Emergency Contact- Phone Number *
ex. 502-123-4567
Your answer
Insurance Company *
Health Insurance Provider
Your answer
Insurance Policy Number *
Health Insurance Policy Number
Your answer
Family Doctor- Name *
Your answer
Is your child presently on medication? *
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