7-12 Club Registration – Perry Meridian Wrestling

MIDDLE & HIGH SCHOOL REGISTRATION

7-12 Club Registration

Wrestler's Name

Last Name

Birth Date

Age

USA Card #

Grade

School

Address

Add a 2nd Wrestler

Wrestler #2 Name

#2 Birth Date

#2 Age

#2 USA Card #

#2 Grade

#2 School

# 2 Address

Same as Wrestler 1

Different than Wrestler 1

#2 Address

Parent/Guardian Name #1

Parent/Guardian Email #1

Parent/Guardian Phone #1

I hereby authorize the Directors of the Club to act for me according to their best judgement in any emergency requiring medical attention, and hereby waive and release the Club from any and all liability for any injury and/or illness incurred while participating in the Club.

Number of Wrestlers Registered

1 Wrestler

2 Wrestler

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