CHECK ONE: Wrestler: _____ Cheerleader _____ PERSONAL: Weight: _______ Age: ______ Grade: _______ Birth Date: ________________
Child’s School: Holland Milford LDW Alexandria Middle Frenchtown Kingwood Other ______________
PLEASE PRINT CLEARLY Last Years League Tournament Placement: _________or years of Experience________________
Child's Name: ___________________________________________________ Mother's Name & Phone ____________________________________________
Home Phone#___________________________________________________ Father's Name & Phone _____________________________________________
Address: _______________________________________________________ Guardian’s Name and Phone ________________________________________
City, State, Zip: _________________________________________________ Parent's or Guardian’s E-Mail Address: _________________________________
Township: ______________________________________________________ _________________________________________________________________
IN CASE OF AN EMERGENCY WHEN THE PARENT OR GUARDIAN CANNOT BE CONTACTED, PLEASE CONTACT:
Name: _______________________________ Relationship: ______________ Address: _____________________________Telephone: ___________________
Doctor/Family Physician: __________________________________________ Phone Number: ____________________________________________________
Medical Insurance Company Name: _________________________________ Policy Number & Group ID: _________________________________________
List all medical conditions (allergies, asthma, medications, etc.) that the organization should have knowledge of or be concerned about: _______________
__________________________________________________________________________________________________________________________________
I hereby give my child permission to participate in the Del Val Rams Wrestling of Holland Township, Inc program as a wrestler. I release all tournament officials, referees, coaches, RRR members, its officers and committee persons from any and all liability in connection with my child's participation.
We as participant, parent/guardian, I agree to uphold the rules and obligations of this organization and its associated leagues as outlined in their respective By-laws.
I as a parent/guardian hereby pledge to provide positive support, care and encouragement for my child participating in youth sports by following the Parents Code of Ethics Pledge as noted in the organizations By-laws.
I as a participant hereby pledge to provide positive attitude and be responsible for my participation in Youth Sports by following the participant’s Code of Ethics as noted in the organizations By-laws.
Parent/Guardian's Signature: _______________________________________ Participant's Signature: __________________________________________
FUND RAISER OPTIONS: 1. _________ FUNDRAISER ($ 30.00, Hershey's Fundraiser)
2. _________ FUNDRAISER WAIVER ($ 40.00)
3.
SIGN-UP COSTS: 1. _________ Early Registration Fee: $ 60.00/participant (mail in registration from 4/10 – 9/15) - Additional family members @ $ 50.00/participant (mail to Del Val Rams, PO Box 291, Milford, NJ 08848
2. ___ ______ Regular Registration Fee: $75.00/participant (until 10/21) - Additional family members @ $ 65.00/participant
3. _________ Late Sign-Up Fee: $ 80.00/participant (after 10/21) no exception
TOTAL REGISTRATION FEE: $ _______________
WORK BOND: $50.00 - 1 Check per family exclude if bond is listed on a sibling’s registration form. Check #________________________
METHOD OF PAYMENT: _____________________ CASH (enter full amount paid) ______________________ CHECK _____________________ CHECK #
RAMS T-SHIRT
CHILDS NAME_________________________
YOUTH SIZE: S M L
ADULT SIZE: S M L
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