2017-2018 Bartlesville Wrestling Club Registration
Wrestler Information
Wrestler Name *
Your answer
Date of Birth *
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/
DD
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YYYY
Current grade *
Your answer
Estimated Weight
Your answer
Experience / Skill Level *
Shirt Size *
Parent / Guardian Information
Parent/ Guardian Name *
Your answer
Address *
Your answer
Phone Number *
Your answer
Email *
Your answer
Emergency Contact
Emergency Contact Name *
Your answer
Relationship *
Your answer
Emergency Contact Phone Number *
Your answer
Medical Information
List any medical information coaches need to be aware of
Your answer
Birth Certificate
A copy of the wrestler's birth certificate will be required *
Informed Consent
Informed Consent - Agreement
If my child needs medical treatment while participating, Medical Personnel will be called and treatment will be started while attempts are being made to reach me. I hereby give my approval for my child's participation in any and all activities prepared by Bartlesville Wrestling Club. In exchange for the acceptance of said child's candidacy by Bartlesville Wrestling Club, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve, and hold harmless Bartlesville Wrestling Club, and all its respective coaches, clinicians, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from all club activities. In case of injury to said child, I hereby waive all claims against Bartlesville Wrestling Club, including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including wrestling. CONFORMATION: BY ACKNOWLEDGING AND CLICKING "YES", I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE *
I give my permission for my child's name and photograph to be on the club's website and Facebook and/or newspaper or other media
Payment
To pay by debit or credit card, please submit this form an then return to the homepage. There is a paypal link on the website. Payments will also be accepted at in person registrations, or at practice. Accepted forms of payment include: cash, check, credit/debit cards. Registration Fees: $100 Additional Siblings: $50 USA Membership: $15 (limited/ OK only) $35 (Full Membership)
Your answer
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