Registration - Wrestling Prospect Camp

Camp Session:

Camp Session: 6/8/2024 6/22/2024
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 Country
Home Phone: Home Phone: - ### - ### ####
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 in 2023:
Expected Weight Class
Shirt Size:

Shirt Size: Small Medium Large XL 2XL 3XL
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: