Registration

Please fill out the online form to the right and submit. Please remember to mail payment or deliver to:

[Address]

You may also print the form below and mail it in or drop it off.

Printable Form

REGISTRATION FORM

Name

Address

Apt, suite, etc.

Country

City

State

Zip code

Grade

Weight

Birthdate

Parent/Guardian Name

Home Phone

Primary Phone

Secondary Phone

Do you have a primary health insurance policy?

Yes

Insurance Company

Policy Number

Medical Conditions

Allergies

Emergency Contact

Emergency Primary Phone

Emergency Secondary Phone

Waiver of Responsibility

I/We agree to the statement below

I/We the parents or guardian of the above named wrestler/child hereby give my/our approval for my/our child to participate in Ogallala Youth Wrestling practices &/or tournaments; and I/we for myself/ourselves, my/our heirs, executors and assigns do hereby waive, release, absolve, indemnify and agree to hold harmless the Ogallala Youth Wrestling, and the Ogallala Public Schools, the organizers, sponsors, participants, coaches, directors; for any claim arising out of an injury to my/our child, whether the result of negligence or from any other cause. In the event of a medical emergency affecting my/our child and I/we am/are not present. I/we hereby give my/our consent to seek emergency medical treatment for my/our child. I/we will furnish a birth certificate of the above named child to club officers if requested. I/We also agree to return by the deadline of May 15 of the current year, the singlet and other equipment issued to my/our child as good as condition as when received, except for normal use or wear and tear. I/We have read the above waiver and release. I/We have signed it voluntarily. By signing this waiver you are allowing your child’s name and/or image on our website.

Accept my typed name as signature

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