OAK HARBOR AMATEUR WRESTLING CLUB
APPLICATION
Name:________________________________Telephone:_________________________
Address:___________________________ E-Mail Address:_______________________
City:__________________ Zip:____________ Emergency No:____________________
School:_______________________________ Cell Phone:________________________
Age:_____ Grade:______ DOB:_______ Weight:_______
Years of wrestling experience:_____________
T-shirt size for wrestler: Child 10-12(M) 14-16(L) Adult S - M - L - XL (please circle one)
Parent's Signature:_______________________________________________________
PARENTAL INSTRUCTIONS CONCERNING MEDICAL TREATMENT
(must be completed before acceptance into Oak Harbor Amateur Wrestling Club)
Wrestlers Name:____________________ Parent/Guardian Name:__________________
Address:_______________________________________________________________
Tel: Home:_________________________ Work:_______________________________
Please indicate another person to contact in the event of an emergency and we are unable to reach you
:Name:___________________ Relationship:_____________ Phone:________________
Insurance Co:______________________ Policy No:____________________________
Is your child presently on medication?___________ Drug sensitivities:______________
Other Allergies:__________________________________________________________
Please read the alternative statement below and sign under the one that you choose.
DO NOT SIGN MORE THAN ONE!!!!
1. If my child needs medical attention, it is my wish that I be contacted before any medical procedures are done on my child, unless immediate treatment is necessary to save my child's life or to prevent permanent injury.
Signature of Parent/Guardian:______________________________ Date:___________
2. If my child needs medial treatment while participating, it is my wish that treatment begins while efforts are being made to contact me. So the treatment is not delayed, I consent to any medical procedure that the physician believes needed, on the understanding that efforts will continue to be made to contact me. I accept responsibility for all costs related to such treatment.
Signature of Parent/Guardian:_______________________________ Date:___________
DO NOT FILL IN- Treasurer will complete:
Biddy Wrestling Fee paid on this date:_________ Check No:_________ Cash:________