*Wrestler's Last Name:	*Wrestler's First Name:
*Street Address 1:	Street Address 2:
*City: *State:   AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY	*Zip:
*Home Phone:
*Wrestler's Birthdate:	mmm: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec   dd: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   yyyy: 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986
*Wrestler's Age:	*Wrestler's Grade:  4K 5K 1 2 3 4 5 6 7 8 9 10 11 12
*Wrestler's Weight: lbs

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Participation in wrestling requires the ability to endure intense aerobic and anaerobic activities. Also, participation requires the capacity to understand the rules of the sport. Does your child have any current condition that limits his ability to participate in these activities?	Yes No If so, please explain the condition.
I/We, the parents of the above named wrestler, authorize Alabaster Youth Wrestling Association (AYWA) to publish pictures of my/our child on AlabasterWrestling.org	Yes No
I/We, the parents of the above named wrestler, know that participation in wresting may involve serious injuries. I/We do hereby waive, release, absolve, indemnify and agree to hold harmless AYWA, USA Wrestling, the coaches, sponsors, and participants for any claims arising out of any injury to my/our child, whether the result of negligence or for any other ...	Yes
I/We, the parents of the above named wrestler, also understand the refund policy. No refund will be made after one (1) calendar week of participation by named wrestler. If a wrestler requests a refund prior to one (1) calendar week of participation, 50% of the registration fee will be refunded.	Yes

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*List any email addresses at which you would like to receive AYWA team mailings (practice, fees, tournament information, etc.)
*Primary Email:	Secondary Email:
Dad's Name:	Mom's Name:
Dad's Work Phone:	Mom's Work Phone:
Dad's Cell Phone:	Mom's Cell Phone:
Dad's Signature: By entering/typing in your name, you are officially signing this form. If you'd rather sign a 'hard' copy later, type "No Sign" in the above "Dad's Signature" field.	Mom's Signature: By entering/typing in your name, you are officially signing this form. If you'd rather sign a 'hard' copy later, type "No Sign" in the above "Mom's Signature" field.
Dad's Signature Date: mmm: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec   dd: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   yyyy: 2008 2009	Mom's Signature Date: mmm: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec   dd: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   yyyy: 2008 2009

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Select Wrestler's T-shirt Size:

Youth Small	Youth Medium
Youth Large	Adult Small
Adult Medium	Adult Large

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Medical Release Information

Parent or Guardian Authorization: In case of emergency, if I, or the family physician, cannot be reached, I hereby authorize my child to be treated by Certified Emergency Personnel (i.e. EMT, First Responder, ER Physician).
Family Physician:	Physician's Phone:
Physician's Street Address:	City:
Hospital Preference:
In Case of Emergency:
Emergency Contact 1 Name:	Emergency Contact 2 Name:
Contact 1 Work Phone:	Contact 2 Work Phone:
Contact 1 Relationship to Wrestler:	Contact 2 Relationship to Wrestler:
Contact 1 Home Phone:	Contact 2 Home Phone:
Contact 1 Cell Phone:	Contact 2 Cell Phone:
Contact 1 Pager:	Contact 2 Pager:

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Please list any medical problems or conditions, including conditions that require maintenance medications (i.e. diabetic, asthma, seizure disorder). Also include medical diagnosis, medication, dosage, and frequency of dosage.	Please list any allergies below:
The purpose of the above listed information is to ensure that medical personnel have details of any medical concern, which may interfere with or alter treatment.
Please list any comments, questions, notes, etc. below:

WARNING: Protective equipment cannot prevent all injuries that an athlete might receive while participating in wrestling.

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Thank you!

Season cost is $170, with a $50 discount for each sibling.

There are three ways you can pay:

1. You can come to registration at Warrior Wrestling Complex on October 20, 23, or 26, and while your wrestler tries out the mats, you can pay your fees.
2. We now have PayPal available so you may pay the fees with an eCheck or credit card (e.g., Visa, MasterCard, Discover, and American Express) without the worry of exposing your credit card number. The only drawback is that we (AYWA) must charge a small transaction fee ($5.38 for first wrestler, and $3.89 for each sibling) to cover the amount that PayPal.com charges us.

   To Pay With PayPal

   Click on the "View Cart" button below to Check Out
   Click on the "Add to Cart" button below to add fees for first wrestler - $175.38 Enter 1st Wrestler's Name Below	Click on the "Add to Cart" button below to add fees for siblings - $123.89 each Enter Next Wrestler's Name Below
   Click on the "Add to Cart" button below to add fees for siblings - $123.89 each Enter Next Wrestler's Name Below	Click on the "Add to Cart" button below to add fees for siblings - $123.89 each Enter Next Wrestler's Name Below
   Click on the "View Cart" button below to Check Out

   
   
   

3. OR ... Make your check payable to: AYWA or ALABASTER YOUTH WRESTLING ASSOCIATION and then mail it to:

   Alabaster Wrestling
   Attn: Registrar
   P.O. Box 231
   Alabaster, AL 35007