2024 Pinedale Pummelers Wrestler Registration
Registration is $75 for first wrestler, $65 for each additional wrestler. Payment is due before the first practice in January.

Once registration is submitted you will receive an email from the club with additional paperwork requirements.  

*Your child will not be allowed to participate if we do not have all signed paperwork and payment.

*Check Payable to Pinedale Pummelers or Venmo @ Pinedale-Pummelers

Thank you,
Pinedale Pummelers Board of Directors
Sign in to Google to save your progress. Learn more
Athlete First Name *
Athlete Last Name *
Athlete Date of Birth *
MM
/
DD
/
YYYY
Athlete T-shirt size *
Required
Athlete Physical Address *
Athlete Mailing Address (if differnt than above)
City *
Zip Code *
Main Contact Phone Number (numbers only XXX-XXX-XXXX) *
Main Contact Alternate Phone  (numbers only XXX-XXX-XXXX) *
Parent 1 First Name *
Parent 1 Last Name *
Parent 1 Email *
Parent 2 First Name
Parent 2 Last Name
Parent 2 Email
Emergency Contact Name(s) *
Emergency Contact Home Number *
Emergency Contact Work Number
Emergency Contact Cell Number
Insurance Company (Not Required)
Is your child presently on any medications? If yes, please list: *
Does your child have any drug sensitivities? If yes, please list. *
Does your child have other allergies? *
Has your child ever had an epileptic seizure or been informed that you might have epilepsy? *
Required
Has your child ever been treated for Diabetes? *
Required
Has a medical doctor ever told you that your child has ever been anemic or had sickle cell anemia? *
Required
Does your child have asthma? What medications do they use? *
Does your child presently have an unrepaired hernia? *
Required
Has your child ever been "knocked out" or experienced a concussion during the past 3 years? If so, please provide dats, also include if child was required to stay overnight in the hospital. *
Has your child ever had an injury to their neck involving nerves, vertebrae, or discs that incapacitated them for a week or longer? If yes, please provide dates of each injury. *
Does your child wear any denal appliances? If so, please mark appropriate appliance:
Does your child wear contact lenses during competition? *
Required
Has your child had a fracture during the past 2 years? If so, please indicate which bone was broken and date it happened. *
Has your child had a shoulder dislocation, seperation or other shoulder injury in the past 2 years that incapacitated them for a week or longer? if yes, please give date of injury. *
Has your child ever had a surgery to correct a Shoulder condition? If yes, please provide dates of surgery. *
Has your child ever had an injury to their back? *
Required
Does your child experience pain in their back? If so, indicate frequency. *
Has your child injured their knee during the past 2 years with severe swelling as a result? *
Required
Has your child ever been told that they injured ligaments and/or cartilage of either knee? If so, was surgery completed? Please include date of surgery. *
Has your child ever experienced a servere sprain of either ankle during the past 2 years? *
Required
Has your child ever had an injury to their foot or toes in the past 2 years? If yes, please explain. *
Does your child have any chronic conditions that have not been mentioned above? If so, please explain. *
(Electronic Signature)  The questions on this form have been answered completely and truthfully to the best of my knowledge. *
Parent/Gaurdian Signature
Date of electronic signature *
MM
/
DD
/
YYYY
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms