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Name ___, ____ (Year)
Athlete's Name
First
Last
Gender
Male
Female
Address
Street Address
Address Line 2
City
State
Home Phone Number
Parent's Cell Phone
Parent Email
Email #2 (Optional)
Date Of Birth
Health Care Number
Food Alergies
T-Shirt Size
Extra Small
Small
Medium
Large
Extra Large
X Extra Large
Weight
School
Experience Level
Level 1 (Beginner)
Level 2 (Experienced)
I give permission for pictures of the above registrant to be published on the Golden Legacy Wrestling Club Website & Facebook.
Yes
Parent #1 First Name
Parent #1 Last Name
Parent #2 First Name
Parent #2 Last Name
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ADDRESS: 22211 MILES ROAD MOUNT HOPE ON LOR 1WO
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