James L. Day Wrestling Club Registration

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So you want to learn wrestling? Excellent! Get a parent or guardian to help you with this registration form.

Email *

Wrestler's Last Name *

Wrestler's First Name *

Gender *

Female

Male

Prefer not to say

Can you attend 2 to 6 practices a month after school in the Day Middle School MPR? Usually 3-4:30pm *

Yes

Would you be interested in being a club officer or representative? *

Yes, not sure what

Yes, maybe President or Co-President

Yes, maybe Secretary

Yes, maybe a 6th grade representative

Yes, maybe a 7th grade representative

Yes, maybe an 8th grade representative

Yes, maybe a Girls representative

Required

Mom's/Guardian's Name

Mom's/Guardian's Mobile Phone #

Dad's/Guardian's Name

Dad's/Guardian's Mobile Phone #

Parent/Guardian Email

Address

City *

Grade *

Advisement Teacher *

Weight (approximate)

Emergency Contact *

Emergency Contact's Phone Number *

Any physical limitations or medical conditions *

WAIVER AND RELEASE AGREEMENT : By clicking the box below I give permission for my son/daughter to wrestle at James L. Day Middle School. I understand that Day Middle School and Mr. Helm are not liable for any injuries that may occur to my child during wrestling. I am signing a separate “Hold Harmless” agreement and returning that to Mr. Helm. *

Parent/Guardian Signature

Required

Name of Parent/ Guardian *

Submit

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