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Apex Fall Session
Registration is a two step process. Fill out the registration form below. After you hit submit, you will be forwarded to another page to complete payment.
Wrestler Information
First Name
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+
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Age
11
12
13
14
15
16
17
18
19
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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.
Other Comments
None.
Neither Apex Wrestling nor the staff of Apex Elite assumes 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.
Jason Bovenzi | 585.802.5799 |
APEXWRESTLING@rochester.rr.com