Programs Form - Ukiah Wrestling

Registration Form

Thank you for completing your payment! Please fill out the form below for each athlete you have registered.

Important Notes:

USA Wrestling Athlete Membership: All UWC members must have a USA Wrestling athlete membership to participate in any of our club programs.
- High School Wrestlers: If you are a high school wrestler and don’t have your membership number yet, please contact your coach to obtain it. If you don’t have it right now, you can enter “XXXX” temporarily.
- K-8th Graders: You must purchase this membership on your own. Join USA Wrestling with a free account.
Multiple Athletes: If you are registering more than one K-5th grade athlete, ensure you complete this form for each child. Your discount has already been applied during payment.

Please double-check all information before submitting to avoid delays in processing.

Athlete's Name

Athlete's Last Name

USA Card # (If in high school you can only write XXXX)

Address

City

State

ZIP

Date of birth

Grade

Years of experience

Mother/Father Name (or Legal Guardian)

Primary contact?

Phone

Alt. Phone

Mother/Father Name (or Legal Guardian)

Primary contact?

Phone

Alt. Phone

Emergency Contact Information

Name

Relationship

Phone

Alt. Phone

Medical

Medical Insurance carrier

Policy #

Family Dr

Medical facility of choice

Medical/Special instructions/Allergies

If, during the course of my son’s/daughter’s activities with the Ukiah Wrestling Club, he/she should be ill or sustain an injury, I hereby authorize the coaches to obtain emergency medical/dental care if necessary. I will assume financial responsibility for the bill incurred through my insurance company.

Parent/Guardian Signature

Date

Event Participation Interest / Volunteer

This is a volunteer program. Without the selfless dedication of volunteers, this program would not exist. Please consider helping us out even if you have no experience at all. We would love to see you there.

Check any/all that apply:

Parent / Guardian Agreement

I, the parent of the above child hereby give my approval to his/her participating in any and all wrestling activities during the current sport season. In consideration of my child’s registration, I hereby declare that I understand the inherent risk in contact sports, and he/she participates at his/her own risk, and will not in any way hold liable the clinicians, coaches, organizer, sponsors, participants, or the Ukiah School District for any injuries or losses sustained while competing in or traveling to or from any wrestling activity.

Printed Name

Date

Shirt Size

Short Size