REGISTRATION FORM

 

   DRILLMASTERS                                                             Complete Steps 1, 2 & 3

STEP 1: Wrestler/Family Information (Complete One Form per Child & PRINT Clearly)

 

Wrestler: __________________________________        __ Girl   __ Boy        Age: _____        Birthdate: ____/____/____

                         (Last Name)                (First Name)        (MI)

Mailing Address:  
                        (Street)                                                                     (City)                                                                 (State)            (Zip Code)
Home Phone: (____) ____-______       Medical Conditions:  
Previous Experience:  __Yes   __ No   >>> If Yes, Number of Years: _____ Where:  
Father:    Bus Phone: (____) ____-______
Mother:    Bus Phone: (____) ____-______
Emergency Contact:    Phone:         (____) ____-______

STEP 2: CLASS INFORMATION & ACKNOWLEDGEMENT

 

 
 
   
     
     
     
     
     
 
TUITION & FEES
Tuition____________
USA Card____________
Discount (Inquire)____________
TOTAL____________
Less Amount Enclosed____________
Balance Due____________
 

 

As a legal guardian of the above named student, I certify that he/she is physically fit to perform in all programs at Drillmasters, is not currently under medical care, and is not receiving medication for any condition which would limit participation in any way except as listed above.  I understand that this activity contains the risk of accidental injury and that this risk can never be totally eliminated, even under the supervision of properly trained and qualified instructors.

 

___________________________________________  _________________

(Legal Guardian’s Signature)                                                    (Date)

STEP 3: ACKNOWLEDGEMENT

Please read the alternative statements below and check the space next to the ONE that you choose.  Do not check more than one!  Please sign your name below to verify this agreement.

To be completed if the wrestler is less than 18 years of age.

 

1.____ If my child needs medical attention, it is my wish that I be contacted before any medical procedures are done on my child, unless immediate treatment is necessary to save my child’s life or to prevent permanent injury.

 

2.____ If my child needs medical treatment while participating, it is my wish that the treatment begin while efforts are being made to contact me.  So that treatment is not delayed, I consent to any medical procedures that the physician believes needed, on the understanding that efforts will continue to be made to contact me.  I accept responsibility for all costs related to such treatment.


Signature of Parent/Guardian:  
 
Date:  
Signature of Competitor:  
 
Date: