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  • 2011 Takedown Club Registration

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    Jeff N Peggy Perkins
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    The document is a registration form for the Summerville Takedown Club for the 2011 season. It requests information such as the wrestler's name, birthday, grade, school, weight, years of experience, parent contact details, emergency contacts, medical information, and t-shirt size. It also notes the registration fee of $110 with a $75 fee for additional siblings and includes fields to record payment details and how the registrant heard about the club.

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    The document is a registration form for the Summerville Takedown Club for the 2011 season. It requests information such as the wrestler's name, birthday, grade, school, weight, years of experience, parent contact details, emergency contacts, medical information, and t-shirt size. It also notes the registration fee of $110 with a $75 fee for additional siblings and includes fields to record payment details and how the registrant heard about the club.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    35 views1 page

    2011 Takedown Club Registration

    Uploaded by

    Jeff N Peggy Perkins
    The document is a registration form for the Summerville Takedown Club for the 2011 season. It requests information such as the wrestler's name, birthday, grade, school, weight, years of experience, parent contact details, emergency contacts, medical information, and t-shirt size. It also notes the registration fee of $110 with a $75 fee for additional siblings and includes fields to record payment details and how the registrant heard about the club.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 1

    SUMMERVILLE TAKEDOWN CLUB

    Registration Form - 2011


    $110 Registration Fee
    $75 additional sibling
    Please Print Clearly

    Make Checks Payable to Summerville


    Takedown Club
    Cash $______Check #_______/$_____

    Contacted: ______________
    Signed Waiver: Yes / No

    Wrestler's First Name _______________________________


    Wrestler's Last Name _______________________________
    Birthday _________/_________/__________
    Age ____
    Grade in School _____
    Name of School (i.e. Beech Hill ES) _______________________________
    Weight: ______
    Years of Past Experience _______
    Parent's First Names (Mom & Dad) _______________________________
    Parent's Last Name _______________________________
    Home Phone Number______________________________
    Work or Cell Phone Number __________________________________________
    E-Mail Address _____________________________________________________
    Home Mailing Address ________________________________________________
    ________________________________________________
    Emergency Contact (Name and relation) ______________________________________ (Phone Number) _________________
    Allergies: Please list and explain reactions/side effects
    Medical: (i.e. Asthma) ________________________________________
    Food: (i.e. Peanuts) __________________________________________
    DAD - Interested in Coaching? _______________________________
    MOM - Interested in Team Mom? _______________________________
    Health Insurance Company Name _______________________________
    How did you find out about the Takedown Club Sign-Ups? _______________________________ (Post & Courier, S'ville Journal Scene,
    School, Soccer, Football, Friends, etc.)
    T-Shirt Size for Wrestler?
    Youth S (6-8) M (10-12) L (14-16)

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