ENROLLMENTFORM

I hereby apply for membership to the Spartan Youth Wrestling Club.. As a member I will be entitled to the rights and privileges of membership. The sole purpose of the Spartans a nonprofit organization, is to provide the children with competitive wrestling so that they learn the ideals of sportsmanship, honesty, loyalty, and courage.

PLEASE PRINT

CHILD'S NAME_______________________________________BIRTHDATE____/____/____AGE_____

(LAST)

(FIRST)

ADDRESS______________________________________________________________________________

CITY_________________________________STATE_________________________ZIP________________

PARENTS NAME(S)_____________________________________________________________________

HOME PHONE(____)_______________________________CELL(____)___________________________

EMERGENCY#(____)_______________________________CONTACT____________________________

EMAIL ADDRESS_______________________________________________________________________

YRS. WRESTLING_____CLUBS______________________SCHOOL_____________________________

MEDICAL/ALLERGIES__________________________________________________________________

I, the parent or guardian of the above-named child, hereby give my approval to their participation in any and all activities of the Spartans during the current season. I assume all risks and hazards incidental to the conduct of the activities and transportation to and from the activities. I do hereby release, absolve, indemnify and hold harmlessly the Spartans, the administrators, the officers, and/or all of them. In case of injury to my child, I hereby waive all claims against the sponsors, officers, or any administrator appointed by them, and also give my permission for any necessary emergency treatment to be administered. I will furnish a birth certificate to the above-named child upon request of association officials.

PARENT/GUARDIAN SIGNATURE______________________________________________________

I do____I do not____have medical/accidental insurance coverage.

Insurance Company Name_________________________________________________________________

Group Number__________________________________Policy Number____________________________

Each family is required to volunteer for one or more of the following activities

Coach____Team Parent____Mat Setup/Takedown____Team Pictures____Timer____Fund Raising____

Refreshment Stand____Publicity/Newspaper____Clothing____Board of Directors____

Please Circle Clothing Sizes: (Whatever size you choose, will be the size you are given. Exchanges can no longer be made.)

Sweat Pants:

Youth S (6/8) M (10/12) L (14/16) Adult S M L XL

Sweatshirts:

Youth S (6/8) M (10/12) L (14/16) Adult S M L XL

T-Shirts:

Youth S (6/8) M (10/12) L (14/16) Adult S M L XL

Cost: $90.00 for 1 Wrestler, $160.00 for 2 Wrestlers, $210.00 for 3 Wrestlers in the same immediate family.

Plus additional cost per wrestler for singlets. Please bring a copy of Birth Certificate to registration.

Make Checks Payable to: Spartan Youth Wrestling Club

Mail Payments to: Spartan Youth Wrestling Club

958Woodbourne Drive, Southampton, PA. 18966

Do not write below line-------------------------------------------------------------------------------------------------------------------------------

PAID: $______________ CASH ( ) CHECK ( ) #________

SINGLET DEPOSIT RECEIVED: YES ( ) or NO ( )

All deposits will be reimbursed at the end of the season

I have read and understand the Registration Form, Singlet Return and Volunteer Agreement

___________________________________________________