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Wrestlers Incorporated.

Tyngsborough Youth Wrestling Program

Registration for 2007-2008 Wrestling Season

(to be completed by parent or legal guardian)

NAME:_______________________________________________________________________

ADDRESS:____________________________________________________________________

DATE OF BIRTH:______________________________________________________________

GRADE:______________________________________________________________________

SCHOOL:_____________________________________________________________________

WEIGHT:_____________________________________________________________________

MOTHER/GUARDIAN 1:_______________________________________________________

FATHER/GUARDIAN 2:________________________________________________________

LIVES WITH: (ex: both, mom…)___________________________________________________

YEARS EXPERIENCE:__________________________________________________________

TELEPHONE:_________________________________________________________________

ALT. PHONE 1 (include description; ex/ Dad's cell):_____________________________________

ALT. PHONE 2:________________________________________________________________

ALT. PHONE 3:________________________________________________________________

ALT. PHONE 4:________________________________________________________________

***EMAIL ADDRESS***:_____________________________

ALTERNATIVE EMERGENCY CONTACT 1:

Name________________________ Relationship _____________ Phone ____________________

ALTERNATIVE EMERGENCY CONTACT 2:

Name________________________ Relationship _____________ Phone ____________________

MEDICAL OR SPECIAL CONDITIONS:

________________________________________________________________________________

________________________________________________________________________________

PARENT/GUARDIAN SIGNATURE______________________________________DATE:_________

REGISTRATION INSTRUCTIONS:Complete, sign and 1) this REGISTRATION, together with

2) completed signed CONSENT AND RELEASE FORM and 3) $50 CHECK made payable to

WRESTLERS INCORPORATED and MAIL TO:

Wrestlers Incorporated

11 Emerald Street

TYNGSBOROUGH, MA 01879