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 *
Wrestler's First Name *
School *
Name of school your wrestler currently attends
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)
MM
/
DD
/
YYYY
Street Address *
ex. 1609 Poplar Level Road
City *
ex. Louisville
State *
ex. KY
Zip Code *
ex. 40217
Parent/Guardian-1 email address *
Parent/Guardian-1 Name *
Parent/Guardian-1 Relationship to Wrestler *
Phone Number (parent/ guardian-1) *
ex. 502-123-4567
Parent/Guardian-2 Name
Parent/Guardian-2 email address
Parent/Guardian-2 Relationship to Wrestler
Phone Number (parent/ guardian-2)
ex. 502-123-4567
Emergency Contact- Name *
Person to Contact if you cannot be reached
Emergency Contact- Phone Number *
ex. 502-123-4567
Insurance Company *
Health Insurance Provider
Insurance Policy Number *
Health Insurance Policy Number
Family Doctor- Name *
Is your child presently on medication? *
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