OVERTIME ENROLLMENT APPLICATION: Crystal Lake Location

SUMMER ENROLLMENT OPTIONS
(Summer Application Period : July 1st - August 1st)

Kids (Senior/Novice)

  

High School

 

 
 

GENERAL INFORMATION
Student's Name : First Last : Birth Date (mm/dd/yr):
Mother's Name : Father's Name :  
Home Address : City : State :  Zip Code :    
Home Phone : Work Phone : Cell Phone :
Insurance Company :  
Contact  Email :  

BILLING INFORMATION

Billing Contact : First  Last  :   Home Phone :  
Relation to
Student : 		Is the billing address the same as the home address above ? :  
Billing Address : City : State :  Zip Code :

EMERGENCY CONTACT INFORMATION

Emergency
Contact 1 :		 Relation to Student :
Home Phone : Work Phone :  Cell Phone :
Emergency
Contact  2 :		 Relation to Student :
Home Phone :  Work Phone :  Cell Phone :

STUDENT / ATHLETE  INFORMATION

Age :  Current Weight : Years in wrestling: School Grade:
School : Youth Club:  
Allergies :
Other Physical Conditions :
Current Season Folkstyle Record :

     Wins :

           Losses :

 Current Competitive Weight Class :  
Last Season's Post-Season Finishes : 

Regionals :

   Sectionals :

    State :

 

Please list any other past significant accomplishments and year at the State, Regionals or National level :  FREESTYLE
Please list any other past significant accomplishments and year at the State, Regionals or National level :  GRECO
Grade Point Average    (12 and Up) : Valid USA Card #:

(USA cards expire 8/31 annually)
How did you hear about the Overtime School of Wrestling ?
Comments :

Please check all your information, then hit the Submit button.