Motor City Wrestling Club
2008/09 Wrestler Registration Form
Wrestlers Name:
Date of Birth:
Address:
City:
State:
Zip:
Phone:
E-Mail Address:
Weight:
Years of Wrestling Experience:
Age as of Dec 31, 2009:
School Attending:
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Registration Fee & Uniform:
None
Youth Small
Youth Medium
Youth Large
Youth XL
Adult Small
Adult Medium
Adult Large
Adult X Large
Registration, T-Shirt & Singlet
$70
T-Shirt Size
All fees will be collected at the parents meeting.
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Parent or Guardian:
Phone Number:
Emergency Contact:
Phone Number:
Additional Contact:
Phone Number:
Wrestler's Primary Health Insurance Coverage Company:
Primary Coverage Contract Number:
Yes
No
I (we) do hereby release the Motor City Wrestling Club and it's membership of any
responsibility for injury or illness incurred during practice or participation in a
wrestling event.
Motor City Wrestling Club: 39651 Twenlow, Clinton Township, Mi 48038
Motor City
Wrestling Club
