Register – 3rd & 4th years – Mamaroneck Wrestling

"*" indicates required fields

Before you begin you must have USA Wrestling. To purchase a USA wrestling card visit http://www.usawmembership.com ($45). The USA wrestling card is necessary for insurance purposes and also allows the child to wrestle in tournaments outside of LMYW. You will need a USA Wrestling number to complete your registration form.

Click here for directions on how to purchase or renew your USA wrestling card.

Wrestler's Name*

First Last

USA Wrestling Member Number*

Please enter your USA Wrestling number (8-10 digits)

Wrestler's Address*

Street Address Address Line 2 City ZIP Code

Grade*

School*

Date of Birth*

Years of Experience

How did you hear about our club?

T-shirt Size*

Medical/Emergency Information

Parent 1*

First Last

Parent #1 Home Phone*

Parent #1 Cell Phone*

Parent #1 Email*

Parent 2

First Last

Parent #2 Home Phone (if different from above)

Parent #2 Cell Phone

Parent #2 Email

Child's Allergies

Other Medical Conditions

Child's Physician*

Physician's Phone #*

Medical Insurance Company*

Policy #

Group #

In case of emergency when parents cannot be reached, please contact

Emergency Contact #1 Name*

Relation to Athlete*

Emergency Contact #1 Phone*

Emergency Contact #2 Name*

Relation to Athlete*

Emergency Contact #2 Phone*

Parental Approval and Medical Release*

I understand that I am responsible for my child’s actions and medical bills while he/she is involved with Larchmont Mamaroneck Youth Wrestling. I will not hold Larchmont Mamaroneck Youth Wrestling, its officials, or coaches responsible for any injury that may occur at or going to and/or returning from any Larchmont Mamaroneck Youth Wrestling event.

I certify that my son/daughter is physically fit and not under the direction of physician or medical professional that prohibits or limits his/her activity or ability to participate in this program.

I hereby give my consent to have an athletic trainer, emergency personnel and/or doctor of medicine or dentistry provide my son/daughter with medical assistance and /or treatment in an emergency situation and agree to be responsible for the reasonable cost of such assistance and/or treatment.

I also understand that my child can be removed from the program without reimbursement of registration fees if, in the opinion of the LMYW coaches, the child disrupts activities or displays poor sportsmanship during practices or defaces any property of the Larchmont Mamaroneck Youth Wrestling program.

I understand photos of my child may be taken for the use of the Larchmont Mamaroneck Youth Wrestling program.

I UNDERSTAND THAT DUE TO THE NATURE OF THS SPORT, SOME INTERACTIVE PHSYCIAL CONTACT MAY OCCUR BETWEEN ATHLETES AND COACHES DURING PRACTICE.

I certify that my child is covered under the insurance policy listed on the registration form.

I have read the Parental Approval & Medical Release Policy and agree to support my child and the Larchmont Mamaroneck Youth Wrestling organization to meet the requirements of this policy.

Pricing

Payment Options*

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Please click submit and Coach Gilberti will contact you.

2021 Youth Wrestling Season

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