Registration Form

Columbus

Wrestling Club

Wrestler’s Name                                       Date of Birth                        M/F

Address                                                                                 Phone

Age                   Grade                      School                                                   Weight

       Days:    Sunday Tuesday Thursday



      Time:    5:30-7:00pm

World Class Training Academy:              Gold                      Silver                    Bronze

      T-Shirt Size:                      Youth L ___ Adult S ___   M ____ L ____ XL____

Parents’ or Guardians’ Names                                          Phone:





Email Address

Emergency Contact   :                                                   Phone:

I give my permission for the above-named child to participate in the Columbus Wrestling Club. I understand and agree to hold harmless the Columbus FieldHouse Athletic Center, Performance One and/or its employees and program volunteers from all claims and/or liabilities related to any accident or injury that may occur during my child’s participation.

Signature of Parent or Guardian                                     Date:



For Columbus FieldHouse Use Only

# of Sessions ____Paid      Check No._______    Amt. $_______    Cash $_________