.: Welcome to Apex Wrestling :.

Wrestler Information

First Name

Last Name

Street

City St Zip

Email Address

Phone Number

Cell Number

D.O.B (mm/dd/yyyy)

Yrs. Experience

Age

Grade

Weight

T-Shirt Size

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.

If Paying by Check note above "Paying By Check" and still click Complete Registration below.

Other Comments

Neither Apex Wrestling nor the staff of Apex Tiger 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 Tiger sessions 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.