REGISTRATION

Below you will find the online registration form for the upcoming 2018 season.

Registration costs: $65 for first wrestler, $55 for each additional wrestler.
 • New wrestlers will need to bring a copy of state issued Birth Certificate.
 • Please make sure to print and sign these documents.
      Signature sheets for registration

Wrestlers usually wear shirt, shorts, and wrestling shoes. Headgear and singlets are optional. Wrestling shoes are only to be worn on the mat. This will help us keep our mats clean and bacteria free. Coaches will allow clean gym shoes to be worn for the first couple of practices until you can get wrestling shoes.

If a wrestler is planning to go to a tournament they are required to have wrestling shoes, head gear, and singlets.  Each wrestler will need a blue and a red singlet, or a reversible singlet.

Signature sheets, payment, and registration are required to be able to practice. A wrestler without all paperwork turned in, will not be allowed on the mat.

Athlete Name (First and Last)*

Athlete USA Wrestling Member ID. Fill out only if your child wrestled has wrestled in the past. The number can be found on your child's USA Athlete Membership card.

Athlete Date of Birth*

Athlete T-Shirt Size*

Athlete Physical Address*

Athlete Mailing Address (if different than above)*

Main Contact Phone Number*

Main Contact Alternate Phone Number*

Parent 1 Name (First and Last)*

Parent 1 Email

Parent 2 Name (First and Last)

Parent 2 Email

Emergency Contact Name(s) (First and Last)*

Emergency Contact Phone Number*

Insurance Company

Is your child currently on any medications? If yes, please list:

Does your child have any drug sensitivities? If yes, please list:

Does your child have other allergies?

Has your child ever had an epileptic seizure or been informed that you might have epilepsy?
 Yes No

Has your child ever been treated for Diabetes?
 Yes No

Has a medical doctor ever told you that your child has ever been anemic or had sickle cell anemia?
 Yes No

Does your child have asthma? What medications do they use?

Does your child presently have an unrepaired hernia?
 Yes No

Has your child ever been "knocked out" or experienced a concussion during the past 3 years? if so, please provide dates, also include if child was required to stay overnight in the hospital.

Has your child ever had an injury to their neck involving nerves, vertebrae, or discs that incapacitated them for a week or longer? If yes, please provide dates of each injury.

Does your child wear any dental appliances? If so, please mark all that apply:
 None Permanent bridge Permanent crown or jacket Permanent retainer Removable retainer Braces full plate Removable partial plate

Does your child wear contact lenses during competition?
 Yes No

Has your child had a fracture during the past 2 years? If so, please indicate which bone was broken and date it happened.

Has your child had a shoulder dislocation, separation or other shoulder injury in the past 2 years that incapacitated them for a week or longer? If yes, please give date of injury.

Has your child ever had a surgery to correct a shoulder condition? If yes, please provide dates of surgery.

Has your child ever had an injury to their back?
 Yes No

Does your child experience pain in their back? If so, indicate frequency.
 No my child does not experience back pain Seldom Occassionally Frequently With rigorous exercise With heavy lifting

Has your child injured their knee during the past 2 years with severe swelling as a result?
 Yes No

Has your child ever been told that they injured ligaments and/or cartilage of either knee? If so, was surgery completed? Please include date of surgery.

Has your child ever experienced a severe sprain of either ankle during the past 2 years?
 Yes No

Has your child ever had an injury to their foot or toes in the past 2 years? If yes, please explain.

Does your child have any chronic conditions that have not been mentioned above? If so, please explain.

Electronic Signature. The questions on this form have been answered completely and truthfully to the best of my knowledge. Parent/Guardian Signature.*

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