New Year's Clinic Registration
Get a jump start on the new year by learning great technique and training tips.
Participant(s) Name - add all participants names separated by commas *
Your answer
Session(s) attending *
Required
Number attending each session-select "0" for the session not attending *
0
1
2
3
4
5
2nd-6th grade
7th-12th grade
Participant(s) Date(s) of Birth - add all participants DOB separated by commas
Your answer
Participant(s) school(s) - add all participants schools separated by commas
Your answer
Participant(s) Email add all participants emails separated by commas
Your answer
Participant(s) Social Media (Twitter, IG, Facebook, etc.)
Your answer
Participant(s) USA Wrestling Card Number (if participant has one) add all participant card numbers separated by commas
Your answer
Parents Name *
Your answer
Parents Email *
Your answer
Parents Cell Phone
Your answer
Address, City, State, Zip
Your answer
I verify that my child is physically able to participate in this clinic. I hereby authorize the clinic staff to act for me, according to their best judgment in any medical emergency, while there is an attempt to contact me. I waive and release this clinic from any liability, injuries or illness incurred while my child participates in this clinic. My child shall use the facilities of Waverly HS at his/her own risk. Kerry McCoy, LLC, Waverly HS or any member of the staff shall not be liable for any damages. *
Required
Please provide specific written instructions for any special medical conditions that you deem necessary for your child while participating in this clinic.
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Parent/Guardian Digital Signature *
Your answer
Insurance Company, Name of Policy Holder, Policy Number
Your answer
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