Registration - Women's Wrestling Camp
Registration - Women's Wrestling Camp
Four-Day Fall Clinic
Dates: 9/6/26, 9/13/26, 9/20/26, 9/27/26
Total Cost: $120
Student Name:
Student Name:
*
First
Last
Date of Birth:
Date of Birth:
*
/
MM
/
DD
YYYY
Address
Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Mobile Phone:
Mobile Phone:
*
-
###
-
###
####
Parent/Guardian Email:
*
High School:
*
High School Coach's Name:
High School Coach's Name:
First
Last
High School Coach's Number:
High School Coach's Number:
-
###
-
###
####
High School Coach's Email:
Club:
Club Coach's Name:
Club Coach's Name:
First
Last
Club Coach's Number:
Club Coach's Number:
-
###
-
###
####
Club Coach's Email:
Grade entering Fall
*
Expected Weight Class
*
Emergency Contact Name #1
Emergency Contact Name #1
*
First
Last
Relationship
*
Phone Number 1
Phone Number 1
*
-
###
-
###
####
Emergency Contact #2
Emergency Contact #2
*
First
Last
Relationship
*
Phone Number 2
Phone Number 2
*
-
###
-
###
####
Insurance Company
*
Policy Holder Name
*
Policy Number
*
Please list any food allergies:
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