Bethel Allstars Wrestling PCJWL Season Registration
**Please complete one form per wrestler**

Cost per wrestler
First Child: $175
Each Additional Child: $140
Discounts only available for multi wrestlers within individual families in the same household
Cost Includes:
Registration
USA Limited Folkstyle card - required for insurance coverage - purchased by the club
PCJWL League tournament entry fees
Refundable volunteer deposit - only charged for one child

*****NEW WRESTLERS***** Must Bring COPY of Wrestlers Birth Certificate turned in First Week of Practice
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*
USA Card Number - returning wrestlers only
First Name *
Last Name *
Birth Date *
MM
/
DD
/
YYYY
School Attending *
Age as of Jan 1st *
Grade *
Estimated weight in Pounds *
This is to ensure the club has the correct amount/sizes of singlets.
Do you plan to rent or purchase a competition singlet? *
Singlets will be available to rent for $40 at the beginning of the season. At the end of the season, if the singlet is returned in good condition $20 will be refunded.
In order to run a successful season we need volunteers. Please let us know how you would be willing to help *
How did you first hear about us?
Clear selection
Address *
City *
Zip Code *
PARENT / GUARDIAN INFORMATION #1
Name *
Phone
Email *
PARENT / GUARDIAN INFORMATION #2
Name
Phone
Email
EMERGENCY CONTACT ( OTHER THAN PARENT)
Name *
Phone *
Doctor Name
Phone
Allergies? *
Drug Sensitivities? *
Describe if yes
Is child presently on medication?
Clear selection
List Medication
Preferred Hospital
Insurance Provider/Group Number *
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