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Your Name*

Parent's Name*

Date of Birth* (Month/Day/Year)

Grade*

Grade Level*

Address*:

City/Town*:

County*:

ZIP Code*

Contact Info

  • Phone*:
  • E-mail*:
  • Cell:
  • Emergency Contact*:
  • Emergency Number*:

Note: If you do not have your card numbers, please E-mail later to mike@ohiograpplers.com

  • AAU Card #:
  • USA Card #:

Wrestling Info. (record, accomplishments)

Allergies

Medical Problems

Hobbies

The current year*

Comments:

In consideration of your acceptance of my application, I , my heirs, executors, waive and release Michael Mattin and family, and all coaches, helpers from any and all claims of rights to damage from injuries or losses suffered by me/wrestler, directly during all activities in regards to being at the Mattin wrestling room. I also authorize to obtain treatment from appropriate services if warranted. I also attest that the other parent has no concerns and gives permission to his/her son wrestling and working out at the Mattin Wrestling room.

In lieu of a physical signature, by checking this you are giving a digital signature, acknoledgement, and agreement of the waiver. Click here for the waiver.
 I Agree

 I do... I do not... Want my child to climb a rope that is up to 15 feet high.*

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Note: Birth Certificate - Please scan and E-mail to mike@ohiograpplers.com or fax to 419-822-8293 or mail to address below.

Thanks for filling this out as it allows us to remain organized.

Thanks,
Michael Mattin

OHIO GRAPPLERS
mike@ohiograpplers.com

Ohio Grapplers Wrestling
5755 Township Rd. 6
Delta, OH 43515

Cell: 419-779-6778
Home: 419-822-9007
Fax: 419-822-8293