Lakeland Predators 2021 Registration

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Registration for the 2021 IKWF wrestling season. Please answer all questions as completely as as possible. 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) *

USA Wrestling Card Number *

In order to participate in the 2021 wrestling season, all wrestlers will need to renew their USA Wrestling Athlete membership. The cost is $50 and can be purchased at: https://www.usawmembership.com/login. Please be sure to choose Lakeland Predators WC for your club affiliation. After purchase, you will be able to download and print your wrestlers USA Wrestling Card which displays the USAW ID number.

Age as of September 1st *

Date of Birth *

YYYY

Wrestlers approximate weight *

Male/Female *

Male

Female

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

Mothers Name (Full) *

Mother's Contact number *

Mother's Email Address *

Fathers Name (Full) *

Father's Contact number *

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

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) *

Send me a copy of my responses.

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