Wallkill Valley Wrestling Club 2019-2020

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2018-2019 Wallkill Youth Wrestling Registration Form

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

* Home Phone:

* Birthdate:

* Gender:

* Grade:

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

* EMail:

* Home Phone:

* Work Phone:

* Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

Relationship to Player:

* Insurance Carrier:

* Policy #:

WAIVER INFORMATION

As parent/guardian of the above child, I give permission for my child to be a candidate for the participation in the Wallkill Valley Youth Wrestling Club. My child is a permanent resident of Franklin, Hamburg, Hardyston, or Ogdensburg. I herby waive and agree to hold the club harmless of any claims arising from participation in such programs and assume all risks and hazards incidental to such participation, including transportation to and from activities. In case of illness or injury, I request that the Wallkill Valley Youth Wrestling Club coaches contact me. If I cannot be reached, I authorize the coaches to call the above named emergency contact to seek medical treatment and this document will serve as permission for authorized medical personnel to treat my child. The organization carries limited medical insurance which is intended to supplement your primary insurance. In the event that your child requires medical attention resulting from physical injury, an official from the organization must be notified immediately and our insurance carrier's claim form must be completed within ten days of such inquiry.

I/we agree with the above *

Practice gear consists of button-less/zipper-less sweats, short, t-shirt, sweat shirt, wrestling shoes. Head gear is available or you may purchase one from a local sporting goods store. A wrestling singlet will be lent to each child for the season for use during matches and tournaments. I agree to return the singlet and other equipment issued to my child in clean and good condition. If the singlet or equipment is not returned I will be responsible for its replacement cost.

I/we agree with the above *

WV Wrestling Uniform / Warm Ups

* WV Wrestling TEE Shirt / Choose Size::

* WV Warm Up Shorts / Choose Size: ***PUT SIZES IN THERE****:

***Fight shorts stretch up to the next size and have a drawstring for best fit***

YXS : 40 - 57 LBS
YS: 58-70 LBS
YM: 71-85 LBS
YL: 86-105 LBS
AS: 106- 135 LBS
AM: 136-160 LBS
AL: 161-190 LBS
AXL: 191-240 LBS

*Family Discount: Any family with 2 or more Wrestlers in the Wallkill Valley Youth Wrestling program will receive a $10 .00 rebate check after payment and registration have been completed and received.

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IMPORTANT: Online Payment with credit cards is not active for this form

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2018-2019 Wallkill Youth Wrestling Registration Form