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Registration
Parent Resources
Donate & Sponsor
Events Calendar
Contact Us
Registration and Release (Online)
CHILDS LEGAL NAME
(Required)
First
Last
CHILDS SCHOOL
(Required)
CHILDS GRADE
(Required)
CHILDS DATE OF BIRTH
(Required)
AGE (BY DEC 31)
(Required)
WEIGHT
(Required)
USAW MEMBER #
(Required)
Choose a SHIRT SIZE
(Required)
YOUTH XS
YOUTH S
YOUTH M
YOUTH L
YOUTH XL
ADULT S
ADULT M
ADULT L
ADULT XL
ADULT 2XL
ADULT 3XL
PARENT/LEGAL GUARDIAN MAILING ADDRESS
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
PARENT/LEGAL GUARDIAN #1
(Required)
PARENT/LEGAL GUARDIAN #1 PHONE
(Required)
PARENT/LEGAL GUARDIAN #1 EMAIL
Enter Email
Confirm Email
PARENT/LEGAL GUARDIAN #2
PARENT/LEGAL GUARDIAN #2 PHONE
PARENT/LEGAL GUARDIAN #2 EMAIL
Enter Email
Confirm Email
EMERGENCY CONTACT #1
(Required)
INCASE PARENT / GUARDIAN CAN NOT BE REACHED
First
Last
EMERGENCY CONTACT #1 PHONE NUMBER
(Required)
EMERGENCY CONTACT #2
INCASE PARENT / GUARDIAN CAN NOT BE REACHED
First
Last
EMERGENCY CONTACT #2 PHONE NUMBER
HAS CHILD PREVIOUSLY PARTICIPATED IN WRESTLING BEFORE?
(Required)
YES, CHILD HAS PREVIOUSLY PARTICIPATED IN WRESTLING
NO, CHILD HAS NOT PREVIOUSLY PARTICIPATED IN WRESTLING
WHERE HAS THE CHILD PREVIOUSLY PARTICIPATED IN WRESTLING?
(Required)
DOES YOUR CHILD HAVE ANY MEDICAL, ALLERGIC, OR BEHAVIORAL ISSUES?
(Required)
YES, CHILD DOES HAVE MEDICAL, ALLERGIC, OR BEHAVIORAL ISSUES?
NO, CHILD DOES NOT HAVE ANY MEDICAL, ALLERGIC, OR BEHAVIORAL ISSUES?
PLEASE EXPLAIN YOUR CHILDS MEDICAL, ALLERGIC, OR BEHAVIORAL ISSUES?
(Required)
PHYSICIAN'S NAME
PHYSICIAN'S OFFICE NUMBER
YOUR INSURANCE COMPANY
ID/POLICY #
DO YOU NEED FINANCIAL ASSISTANCE ?
(Required)
YES, WE NEED FINANCIAL ASSISTANCE
NO, WE DO NOT NEED FINANCIAL ASSISTANCE
HOW MUCH CAN YOU AFFORD NOW ?
REGISTRATION - PAYMENT UNDERSTANDING
Parent / Legal Guardian Signature
(Required)
I UNDERSTAND THAT MY REGISTRATION IS NOT COMPLETE UNTIL THE REGISTRATION FEE HAS BEEN PAID IN FULL AND A COPY OF MY ATHLETES BIRTH CERTIFICATE HAS BEEN RECEIVED.
Reset to re-sign.
CONSENT TO MEDICAL CARE AND TREATMENT
ALL CHILDREN REGISTERED WITH THE SHELTON WRESTLING CLUB WILL BE INSURED BY A SECONDARY CARRIER PROVIDED BY USAWRESTLING, EFFECTIVE AFTER PARENT/GUARDIAN INSURANCE HAS BEEN EXHAUSTED. THERE IS A DEDUCTIBLE ON THE USAW INSURANCE. SHELTON WRESTLING CLUB RECOMMENDS A PHYSICAL EXAMINATION FOR YOUR CHILD PRIOR TO PARTICIPATION.
Parent / Legal Guardian Signature
(Required)
I, (PARENT/GUARDIAN NAME LISTED ABOVE) AUTHORIZE ALL MEDICAL AND SURGICAL TREATMENT, X-RAY, LABORATORY, ANESTHESIA AND OTHER MEDICAL HOSPITAL PROCEDURES AS MAY BE PERFORMED OR PRESCRIBED BY A LICENSED PHYSICIAN AND FACILITIES FOR (CHILD’S NAME LISTED ABOVE). IT IS EXPECTED 1 PARENT/GUARDIAN STAYS AT PRACTICE. IF PARENT IS NOT AVAILABLE YOU AUTHORIZE FOR MEDICAL RELEASE.
Reset to re-sign.
HOLD HARMLESS AGREEMENT
WRESTLING IS A VIGOROUS ACTIVITY AND THE POSSIBILITY OF INJURY DOES EXIST.
Parent / Legal Guardian Signature
(Required)
I GIVE APPROVAL AND PERMISSION FOR MY CHILD TO PARTICIPATE IN THE SHELTON WRESTLING ASSOCIATION. I HEREBY WAIVE ALL CLAIMS AND LEGAL ACTION, FINANCIAL OR OTHERWISE, AGAINST THE ABOVE JUNIOR WRESTLING CLUB, IT’S ELECTED AND APPOINTED OFFICIALS, OR ANY VOLUNTEER CONNECTED WITH THE PROGRAM FOR INJURIES WHICH MIGHT OCCUR DURING PRACTICE, TRAVEL OR GAME COMPETITION.
Reset to re-sign.
PAYMENT / FINANCIAL SECTION
HOW DO YOU WANT TO PROCEED ?
(Required)
CHOOSE A PAYMENT PATH
I want to pay ONLINE NOW
I want to register, but need FINANCIAL ASSISTANCE
Consent For Invoice
(Required)
I agree to be billed / invoiced for the registration fee.
I consent to being invoiced for up to $80 registration fee depending on the information provided above in my registration form. I understand that my registration fee must be paid or arrangements for payment are required prior to my child wrestling or attending practice unless otherwise pre-approved.
Confirm Contact Name For Financial Assistance
(Required)
First
Last
Confirm Contact Phone For Financial Assitance
(Required)
Confirm Contact Email For Financial Assistance
Enter Email
Confirm Email
Registration Fee
(Required)
PLEASE CHOOSE FROM ONE OF THE OPTIONS BELOW. IF YOU CHOOSE USA CARD HOLDER, PLEASE BRING YOUR CARD TO NEXT MEETING OR MATCH. FINANCIAL ASSISTANCE IS AVAILABLE, PLEASE CHOOSE THIS OPTION IF YOU ARE NEEDING A LITTLE ASSISTNCE.
GENERAL - REGISTRATION FEE $80
Hidden
GENERAL REGISTRATION - PAYMENT OPTIONS - PLEASE CHOOSE
(Required)
PAY IN FULL TODAY
GENERAL REGISTRATION - PAYMENT PLAN - 1/4 FEE COLLECTED TODAY
-$60.00
Total
Billing First Name
(Required)
Billing Last Name
(Required)
Billing Address For Payment Form
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Contact Phone For Billing Issues
(Required)
Email for Billing Payment Notices
(Required)
Click Here To Contact Us Regarding Registration
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