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West Milford Junior Wrestling

Name:

Phone:

Address:

Town:

Zip:

Birth date:

Age:

Grade:

Height:

Weight:

Wrestling Experience:
Email Address(s)

PLEASE PROVIDE A VALID EMAIL, THAT IS OUR PREFERRED METHOD OF INFORMATION


DISTRIBUTION.
Phone # (where parent can be reached during program)
Emergency contacts:
Name:

Phone:

Name:

Phone:

Wrestlers Sweat Shirt Size:

Youth XS

XL

Adult

XL

Please list any known allergies, physical condition or medications we should be aware of:

My signature below verifies that my child/participant can participate in Wrestling. I understand


photos may be taken for publicity purposes. WMJW reserves the right to revoke the enrollment of
a participant if his/her behavior negatively affects the quality of the program for the other
participants. Refunds must be requested in writing prior to first match. No refunds after the first
match. In the event that I cannot be reached, I give the WMJW permission to seek medical
assistance for my child should it become necessary. As in any activity, there are inherent risks,
and injuries that may occur. I hereby release and discharge the West Milford Junior Wrestling its
Coaches, Board Members, officials, volunteers, commissions, or associations from any and all
actions for losses, damages, or personal injuries to myself or my child which may occur or arise
out of my or my childs participation in the above activity.

Parent Name:______________________ Signature:_________________________ Date:___________

Date:

FOR WMJW WRESTLING USE ONLY


Received by:
Payment method

Fees: Individual $125.00 Family: $175

Check #

Amt. Paid