Central Clarion Area Wrestling Club - Youth Registration 
Season: 2023-2024 

Any Questions contact Bryan Kiskadden:
bryank@mandbgroup.net
814-229-8943
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Wrestler's Name: *
Age (as of 12/31/2023): *
Date of Birth: *
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Weight: *
Address: *
Experience (years):  *
Grade: *
School: *
Mother / Guardian Name *
Mother / Guardian Phone Number *
Text  *
Father / Guardian Name
Father / Guardian Phone Number
Text 
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Mother Email Address: *
Father Email Address: *
Insurance Company: *
Policy #: *
Emergency Contact Name: *
Emergency Contact Phone: *
Our son/daughter named on this form IS covered for athletic injuries by our family insurance. *

I allow my son/daughter's photo to be used on the wrestling facebook page - Clarion Elementary Wrestling

 *

I/we, waive and release the Clarion Area School District, the Central Clarion Wrestling Club, coaches and/or anyone connected with the Central Clarion Area Wrestling Program from any and all claims, liabilities, or rights to damage for any losses suffered by my son/daughter directly from or participating in the Central Clarion Youth Wrestling Program.

 *
I understand that the Participation Fee (this helps cover the cost for (1) Wrestling Tournament Entry Fee) is $50 per child.

Payment Options:
Make checks payable to: Central Clarion Wrestling Club 


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Electronic Signature (Your name): *
Todays Date: *
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