WHEATON WRESTLING ALLIANCE

 

2009-10 REGISTRATION AND INFORMATION FORM: INTRAMURAL PROGRAM

 

Name: _____________________________  Date of Birth: _______________      Grade: ____

School Attended: ____________________            Closest Public School: ______________________

Weight: __________                Height: __________                Shirt Size: __________       Years Wrestled: __________

Address           ____________________________________________________________

            ____________________________________________________________

Parents/Guardians:      Female: __________________            Male: _____________________

            Name               _________________________            __________________________

            Home Phone     _________________________            __________________________

            Work Phone     _________________________            __________________________

            Other Phone     _________________________            __________________________

            e-mail               _________________________            __________________________

 

Check Box:

Practice Location            □  must be Kennedy      □  must be Einstein

 

Consent and Release: I give permission for my child to participate in the Wheaton Wrestling Alliance.  I understand that wrestling is a strenuous sport.  In consideration of the acceptance of this registration, I release the Wheaton Wrestling Alliance, its officers, directors, coaches and/or volunteers from any liability or claims for injury or loss arising out of my child’s participation.  I consent to any emergency treatment administered to my child on my behalf.  I guarantee the return of all uniforms and equipment issued to my child by the Alliance.  If I fail to return the uniforms/equipment within 30 days after completion of activities, I agree to pay the full replacement cost.

 

Parent/Guardian Signature ________________________________            Date ___________

 

Involvement:

_____   I am interested in volunteering as an assistant coach.  Tell me more.

_____   I am interested in volunteering as a TEAM PARENT.  Tell me more.

 

Remarks:

 

 

 

This form may be mailed to:

Wheaton Wrestling Alliance

c/o Bob Batcher

2502 North Gate Terrace

Silver Spring, MD 20906

 

Include full fees of $140 – this includes $45 for gym rental and equipment plus $40 per child for league fees and $30 for USA Wrestling Insurance. Checks should be made out to Wheaton Wrestling Alliance.

For partial payment and/or scholarships contact Bob Batcher at 301-871-1248.

2502 North Gate Terrace ● Silver Spring MD 20906 ● 301-871-1248 ● www.wheatonwrestling.com