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LCN Wrestling Club 2006/07














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Below is the registration Form.

Click Print and it will print the form below.

 

 

 

Registration Form

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                          Registration Form LCNWC 2006

 

Full Name:  __________________________ Age:  _______ DOB:  ___________ 

Address:  ____________________________ City: _______ Zip:  __________

Home Ph#:  ______________Cell#:_____________ Email:_______________

School now attending:  ____________________________ Grade:  _________

Father’s full name:_________________ Work Ph#:  _______

Mother’s full name:  __________________ Work Ph#:  ___________

 

REGISTRATION RELEASE

I give my permission for my child ____________________________ to wrestle with the LCN Wrestling Club and compete in practices, tournaments, dual meets and scrimmages in which this club may become involved.  I also release the LCN Wrestling Club, its members, officers, coaches and their heirs, and/or agents from all responsibilities for loss of property and any injuries or damages sustained in practicing for, competing in or traveling to or from any club events.  I also release LCN School District, LCN High School and those persons responsible for the facilities, their heirs, and/or agents from any responsibility for injury, loss of property and any other damages.

 

Parent/Guardian Signature: _________________________________________

 

MEDICAL RELEASE

I give my permission to a representative of the LCN Wrestling Club to seek medical attention for ____________________________ in case of an emergency if I cannot be immediately contacted.

Please take my child to Dr. _______________________ or to  __________________________

Hospital.  I have medical insurance with (company) ____________________________________

 

      **********List any current medical problems and/or medication which is regularly taken**********

1.      ________________________________________________________________________

2.      ________________________________________________________________________

3.      ________________________________________________________________________

 

                                                                                          WRESTLERS AGREEMENT

I, __________________________ agree to abide by all the rules and regulations set by the LCN Wrestling Club and the Michigan State Wrestling Association.  I agree to display a high level of sportsmanship and treat other wrestlers, coaches, club officers, other members of the club, league officials and all others involved with the highest level of respect.

 

PLEASE COMPLETE A SEPARATE REGISTRATION FORM FOR EACH CHILD REGISTERING WITH THE CLUB.  THE CHILD WILL BE A MEMBER IN GOOD STANDING AFTER COMPLETING THIS FORM, SUBMITTING A PHOTO COPY OF THEIR BIRTH CERTIFICATE AND PAYING THE REGISTRATION FEE.

                                                                                 Club Use Only

____ Birth Certificate     ____ Registration fee      Date: ___________  Cash/Check: __________

____ Singlet (size: _____)   ____ Deposit      Date: ___________ Cash/Check: __________