Lakeland Predators Wrestling 2019-2020

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Registration information for the 2019-2020 season. Please answer all questions as complete as possible. This information is important contact information needed by the club. This information will not be shared with anyone and is only visible to the Board of Directors. Medical information may be shared with coaches if deemed necessary for the safety of all those who will be in contact with the wrestler.

Email *

Wrestler's Full Name (last name, first name) *

Age as of September 1st *

Date of Birth *

YYYY

Male/Female *

Male

Female

Address (House #, City, State, Zip) *

Mothers Name (Full) *

Fathers Name (Full) *

Mother's Contact number *

Father's Contact number *

Mother's Email Address *

Father's Email Address *

Emergency Contact Name *

Emergency Contact Number *

Relationship to wrestler *

New to Lakeland Predators? *

Yes

If you are new to the club, were you referred by a current club member? Who? *

If you have wrestled with another club, please list prior club *

Wrestlers approximate weight *

Insurance Provider *

Insurance Policy Number *

Insurance Group Number *

Preferred Hospital *

Doctor's name *

Any medical conditions we should be aware of? (Allergies, medicine, conditions etc) *

T-Shirt size of wrestler *

Youth Small

Youth Medium

Youth Large

Adult Small

Adult Medium

Adult Large

Adult 2xl

Send me a copy of my responses.

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