Lakeland Predators Wrestling 2019-2020
Registration information for the 2019-2020 season. Please answer all questions as complete as possible. This information is important contact information needed by the club. This information will not be shared with anyone and is only visible to the Board of Directors. Medical information may be shared with coaches if deemed necessary for the safety of all those who will be in contact with the wrestler.
Email address *
Wrestler's Full Name (last name, first name) *
Your answer
Age as of September 1st *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Male/Female *
Address (House #, City, State, Zip) *
Your answer
Mothers Name (Full) *
Your answer
Fathers Name (Full) *
Your answer
Mother's Contact number *
Your answer
Father's Contact number *
Your answer
Mother's Email Address *
Your answer
Father's Email Address *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Number *
Your answer
Relationship to wrestler *
Your answer
New to Lakeland Predators? *
If you are new to the club, were you referred by a current club member? Who? *
Your answer
If you have wrestled with another club, please list prior club *
Your answer
Wrestlers approximate weight *
Your answer
Insurance Provider *
Your answer
Insurance Policy Number *
Your answer
Insurance Group Number *
Your answer
Preferred Hospital *
Your answer
Doctor's name *
Your answer
Any medical conditions we should be aware of? (Allergies, medicine, conditions etc) *
Your answer
T-Shirt size of wrestler *
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