Apex Summer Registration

Step 1 of 2

Fill out the registration form below. After you hit submit, your registration will be complete.

Wrestler Information Athlete First Name Athlete Last Name Street City St Zip AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Email Address Phone Number Cell Number D.O.B (mm/dd/yyyy) Yrs. Experience 1 2 3 4 5 6+ --- Age 11 12 13 14 15 16 17 18 19 --- Grade --- 7 8 9 10 11 12 Weight School Allergies/Medications None. Insurance Provider Policy Number   Payment Information Name of Person Paying NOTE: This information will identify payment for this registration. Please type the PayPal account holder. If you do not have a free PayPal account, then enter the name on the credit/debit card of the person that is paying. Other Comments None. Neither Apex Wrestling nor the staff of Apex Eliteassumes responsibility for accidents or medical expenses incurred as a result of participation. All athletes must assume responsibility for any medical expenses incurred. I have adequate medical coverage and insurance and give my son/daughter permission to attend the Apex Elitesessions and I agree to indemnify Apex Wrestling and its employees for any claim which may hereafter be presented by my child as a result of any such injuries. Photo Releases: I give permission for APEX to use any photographs, digital images, videotapes, DVDs, film, CDs or audio recordings. These items may be used for any reasonable purposes, including but not limited to, Promotional, Fundraising, Advertising, and/or Educational purposes, and need not include the child’s name or any information about him/her. I waive the right to inspect and/or approve the appearance or use of the above-referenced items.