Name:       ________________________________

Birth date:  _______________________________
 
Phone #:    ________________________________

Address:    ________________________________

City:       ________________________________

Zip code:    _______________________________

Email:      ________________________________



Age (as of 12/31/09): ______________



Emergency Contact: ________________________

Phone Number:      ________________________

Relationship to wrestler: _________________

By signing this registration form, parent or legal guardian acknowledges
and fully understands the possibility of injury at this full contact 
sport wrestling club, and hereby assumes all responsibilities for medical 
bills as a result of any injury incurred.  The Redhawk Wrestling Club, 
coaches and officials, and Marist High School (or any other practice 
facility used by the Redhawk Wrestling Club) are not responsible for any 
treatment or financial payment in the event of injury to the athlete that 
may result from going to or participating with the Redhawk Wrestling Club 
in practice or at sanctioned events.  Parents will be contacted 
immediately upon injury.  If life threatening, emergency services will be 
contacted.

Parent/Guardian: ________________________   Date: _____________

Wrestler: _______________________________

You must bring a copy of your birth certificate for the club's files. 
Please print and fill out this form prior to coming to registration.  
Contact Tom O'Brien, 708.422.2840, or Mike Roach, 708.299.9571, for more 
information.  www.RedhawkWC.com.