COBRA Optimist Wrestling Registration Form

COBRA Optimist Wrestling Registration Form
Attention: All Practices will be held at IWCC
Monday: Practices will be held at Iowa Western Community College.

Intermediate: 6:00-7:15 (Starts November 16th)

Tuesday: Practices will be held at Iowa Western Community College.

Beginners: 6:00-6:45 (Starts November 17th)

Thursday: Practices will be held at Iowa Western Community College.

Intermediate: 6:00-7:15 (Starts November 16th)
Parent/Guardian Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Name

First NameLast Name
Emergency Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Read information below before selecting wrestling level
Wrestling Beginner: A beginner wrestler may be in kindergarten, 1st, 2nd or 3rd grade. (3rd grade wrestler who has not talked to a coach about intermediate should practice with the beginner group. This will allow them to learn at a rate more suitable for them)

Wrestling Intermediate: A wrestler that might be in 2nd or 2rd grade that has been wrestling for 3 or more years, or a wrestler that is in 4th-8th grade but is new to the sport. This will allow the wrestler to learn at a rate more suitable for them and have teammates closer to their size.
How many children are you registering?
First Child Wrestling Level
First Child USA ID
First Child Name

First NameLast Name
First Child Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
First Child Gender
First Child Grade
First Child School
First Child Shirt Size
Second Child Wrestling Level
Second Child USA ID
Second Child Name

First NameLast Name
Second Child Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Second Child Gender
Second Child Grade
Second Child School
Second Child Shirt Size
Third Child Wrestling Level
Third Child USA ID
Third Child Name

First NameLast Name
Third Child Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Third Child Gender
Third Child Grade
Third Child School
Third Child Shirt Size
Release of Liability
I hereby give my full permission to my (son/daughter) to participate in Cobra Optimist Club of Council Bluffs activities. I agree to assume full responsibility in case of accident or injury while (he/she) is playing, traveling to or from the scheduled area, or representing (his/her) team in any manner, and do further hereby release and hold forever harmless Cobra Optimist Club of Council Bluffs, its agents and employees, from any liability for any personal injuries, including death or property damage, which may be incurred by my child while playing, traveling to or from the scheduled area, or representing the team in any manner, including but not limited to any claim alleging that the injury or damage was caused by defective equipment owned or furnished by the Cobra Optimist Club of Council Bluffs, or by negligence in the supervision of my child or others. It is the responsibility of each parent or guardian to check their child's insurance for athletic injuries. This signature gives us permission to seek emergency medical care as deemed necessary. This signature also allows Cobra to post pictures on Facebook or our website that have been taken during Cobra Optimist Club of Council Bluffs activities.
I have read the above and agree
Price
Finish By Paying
Payment Amount

prevnext( X )
USDDescription
Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
Should be Empty:

COBRA Optimist Wrestling Registration Form

Finish By Paying

Payment Amount*

Payment Methods

Payment Amount