TWA Level 1 Registration

Parent(s) Name

Wrestler Name

Email:

Phone:

Wrestler's DOB/Age:

Wrestler's Weight:

Emergency Contact Name and Number:

Is your child currently on medication? If so, list medication.

Allergies/Drug Sensitivities:

Please read the alternative statements below and select the one that you choose.

Select Only One!

If my child needs medical attention, it is my wish that I am contracted before any medical procedures are taken on my child, unless immediate treatment is necessary to save my child's life or to prevent permanent injury.

If my child needs medical treatment while participating, it is my wish that the treatment is started while efforts are being made to contact me. So that treatment is not delayed, I consent to any medical procedures that the physician believes are needed, on the understanding that efforts to contact me will continue to be made. I accept responsibility for all costs related to such treatment.

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Monthly Rate

$100