Athletics Registration Form - Wrestling 2018

St. Vincent de Paul Athletics 2018 Wrestling Registration Form

Contact Information
Name of Parent/Guardian
  •  
ADDRESS
PARENT EMAIL
PARENT PHONE --
Secondary Phone --
Emergency Contact Name
  •  
Emergency Contact Relationship
Emergency Phone Number --
FAMILY DOCTOR'S NAME
  •  
NAME OF HEALTH INSURANCE COMPANY
PARENT SIGNATURE
Please enter information for your students. If you have one child - enter information for Child 1 and continue to the Parent Acknowledgement Field (after the Child 3) section of this form).
Child 1
Child 1 Name
  •  
Child 1 Gender MALE / FEMALE
Child 1 Grade
Sports
Child 1 Date of Birth //
  •  
Child 1 Allergies
  •  
Child 1 - MEDICATION RESTRICTIONS/MEDICATIONS?
  •  
Child 1 - STUDENT HEALTH AGREEMENT
  •  
Shopping Basket Select ONE sport.  
Selection Extended

Wrestling | $40.00

  •  
Child 2
Child 2 Name
  •  
Child 2 Gender MALE / FEMALE
Child 2 Grade
Sports
Child 2 Date of Birth //
  •  
Child 2 Allergies
  •  
Child 2 - MEDICATION RESTRICTIONS/MEDICATIONS?
  •  
Child 2 - STUDENT HEALTH AGREEMENT
  •  
Shopping Basket Select ONE sport.  
Selection Extended

NO SECOND CHILD | $0.00

Wrestling | $35.00

  •  
Child 3
Child 3 Name
  •  
Child 3 Gender MALE / FEMALE
Child 3 Grade
Sports
Child 3 Date of Birth //
  •  
Child 3 Allergies
  •  
Child 3 - MEDICATION RESTRICTIONS/MEDICATIONS?
  •  
Child 3 - STUDENT HEALTH AGREEMENT
  •  
Shopping Basket Select ONE sport.  
Selection Extended

NO THIRD CHILD | $0.00

Wrestling | $30.00

  •  
  •  
PARENT ACKNOWLEDGEMENT
Payment

Order Summary
Subtotal
Discount
Sales Tax
Shipping & Handling
Total

Payment Type

  •  

 
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