Club Registration

Parent or Guardian Name *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Wrestler/Student Details

Name of Wrestler/Student *

First

Last

Date of Birth *

Age *

Wrestler/Student Gender *

Male
Female

Your relationship to the wrestler/student *

Parent or legal guardian
Other

Please specify your relationship to the wrestler/student

Club Membership

Membership Level *

Spring Practice Session: Grades K-6 – $125.00
Spring Practice Session: Grades 7-12 – $125.00

Total Membership Cost

$0.00

Emergency Contact

Please provide an alternative contact person in case of emergency. Emergency contacts must be over the age of 18 and capable of caring for the child if you are unavailable.

Emergency Contact's Name *

First

Last

Emergency Contact's Phone Number

Emergency Contact's relationship to the child *

Please provide details

Comments

Release and Waiver of Liability *

I acknowledge that I have read and understand the Release and Liability Waiver linked below.

Please click here to view the Release and Liability Waiver.

Date of Release *

Parent or Guardian Signature *

Clear Signature

By signing above, IN WITNESS WHEREOF, Participant has executed this Release as of the day and year first above. I HAVE READ, UNDERSTAND, AND AGREE TO TITAN WRESTLING CLUB LIABILITY WAIVER.

Wrestler/Student Signature *

Clear Signature

By signing above, IN WITNESS WHEREOF, Participant has executed this Release as of the day and year first above. I HAVE READ, UNDERSTAND, AND AGREE TO TITAN WRESTLING CLUB LIABILITY WAIVER.

BIlling Name *

First

Last

Billing Address

Address Line 1

Address Line 2

City

State

Zip Code

Square *

Card

Name on Card

Sign Up

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Wrestler/Student Details

Club Membership

Emergency Contact

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