FOND DU LAC RECREATION DEPARTMENT
2019/2020 JUNIOR CARDINALS
WRESTLING PROGRAM
Sponsored by the:
Fond du Lac Wrestling Club & Fond du Lac Recreation Department
Parent must complete a form for each child
(PLEASE PRINT)
REGISTRATION FOR (circle one): Cardinal Kids (4K-2nd) Junior Cardinals (3-5th) Middle School
WRESTLER’S NAME: ____________________________________________________
ADDRESS: _________________________________________________________________
E-MAIL (Make legible): _______________________________________________________
E-MAIL (Make legible): _______________________________________________________
MOM’S NAME: ________________________MOM’S PHONE NUMBER: _________________
DAD’S NAME: _________________________DAD’S PHONE NUMBER: _________________
SCHOOL: ___________________ AGE: ____________ BIRTHDATE: ___________________
GRADE: _______ WEIGHT: ____________ (if known-approximate)
T-SHIRT SIZE: Youth small (6-8) Youth medium (10-12) Youth large (14-16)
(circle one)
Adult small Adult medium Adult large
WHAT MIDDLE SCHOOL WILL YOUR CHILD ATTEND?: ______________________________
EMERGENCY CONTACT PERSON: _____________________________________
EMERGENCY CONTACT #: _____________________________________________
EMERGENCY CONTACT RELATIONSHIP TO WRESTLER?: ________________________
SEE OTHER SIDE OF PAPER
I UNDERSTAND THAT ACCIDENT INSURANCE IS NOT PROVIDED BY THE FOND DU LAC WRESTLING CLUB OR THE FOND DU LAC RECREATION DEPT. cIRCLE ONE
YES NO
I UNDERTAND WHAT THE SIGNS AND SYMPTOMS OF A CONCUSSION ARE AND WILL REPORT TO COACH AND DOCTOR IF WRESTLER HAS SYMTOMS. CIRCLE ONE
YES NO
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In consideration of my son or daughters acceptance into the Fond du Lac School District youth wrestling program; I, my heirs, executors, and administrators waive and release parents, coaches, instructors, sponsors, their agents, representatives, committees, and members, from any and all claims or rights to damages, lost articles, and injuries in said program or traveling to or from, or competing in any meet or any phase of the program.
SIGNATURE: ____________________________________________
(PARENT OR GUARDIAN)
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For club use only
Paid: Yes No Cash Check USA CARD# __________________________
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