Scorpions Wrestling School

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NJ Scorpions Registration Form

PLAYER INFORMATION

* First Name:

* Last Name:

Street:

City:

State:

Zip Code:

Home Phone:

Birthdate:

Email:

Gender:

Grade:

* USAW Card Number:

School:

PARENT/GUARDIAN

Firstname:

Lastname:

EMail:

Home Phone:

Work Phone:

Cell Phone:

Membership Options:

I have read the USA Wrestling Federation Card Membership Statement *

I have read the Terms of Membership *

As parent or legal guardian of the above participant, I authorize Scorpions Training Facility, LLC to request medical treatment as necessary to ensure the well-being of participant. We the undersigned, for ourselves, our heirs, executors, and administrators, waive, release, and forever discharge Scorpions Training Center, LLC, it's staff, officers, agents, representatives, employees, successors, and assigns of and from any and all claims for damages to person or property which may occur or be sustained during participation in Scorpions Training Center LLC, or travel to and from the facility, whether said damages, injury or loss are due to negligence or not.

I/we agree with the above *

* indicates required fields

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NJ Scorpions Registration Form