PHW Club Registration 26-27

Pleasant Hill Wrestling Club 26-27
Wrestler Name

First NameLast Name
Wrestler DOB NOTE: Wrestler must be 5 years old as of Nov 10, 2026

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Grade Level
School
T-Shirt Size
Short Size
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
1st Parent/Guardian Name

First NameLast Name
1st Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
1st Parent/Guardian Email
example@example.com
2nd Parent/Guardian Name

First NameLast Name
2nd Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
2nd Parent/Guardian Email
example@example.com
Emergency Contact (If we are unable to reach Parent/Guardian)

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Insurance Information

Company NamePolicy#
Doctor's Information

Doctor NameDoctor Phone Number

WRESTLER’S AGREEMENT
I agree to participate with Pleasant Hill during the 2026-2027 season or until I am given a release from the Pleasant Hill staff.

CODE OF CONDUCT
As a wrestler, I understand that I must follow these rules to be in good standing:
1. Respect the sport, play fairly and follow it’s rules and regulations.
2. Show respect for authority to the officials of the sport.
3. Demonstrate good sportsmanship before, during and after events.
4. Be courteous to opposing teams and treat all wrestlers and coaches with respect.
5. Be modest when successful and gracious in defeat.
6. Respect the privilege of the use of public facilities.
7. Refrain from the use of drugs, tobacco, alcohol and abusive language.

CODE OF CONDUCT PARENTS
1. Encourage good sportsmanship by demonstrating positive support for all wrestlers, coaches, fans and officials at
tournaments, practices and other sporting events.
2. Place the well being of my child before a personal desire to win.
3. Advocate a sports environment for my child that is free of drugs, tobacco, alcohol and abusive language, and
refrain from their use during events.
4. Encourage my child to play by the rules and respect the rights of other wrestlers, coaches, fans and officials.

PARENTS WAIVER OF LIABILITY AND PERMISSION
I give my permission for my child to participate in the Pleasant Hill Wrestling Club. I herby release the Pleasant Hill Wrestling Club and its management, coaches, volunteers, member/athletes, and sponsors from any and all liability or responsibility for any and all claims, causes of actions, risks, harm, injuries, losses, damage, costs and/or expenses (including attorneys’ fees), known or unknown, foreseen or unforeseen, which may result from or relate to my or my child’s participation in the Pleasant Hill Wrestling Club, even if alleged to be the fault of or caused by the negligence or carelessness of the Pleasant Hill Wrestling Club, volunteers, officers, coaches, directors, agents, servants, successors, heirs, executors, administrators and assigns. I also hereby give my permission for the Pleasant Hill Wrestling Club to seek emergency medical attention in the event of injury during practice or any wrestling event if a parent or legal guardian is not available.
Name

First NameLast Name
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

PARENT, please select each line, indicating you have read, understand and agree to these additional provisions:

Time, Volunteering, Fundraising: I understand that Pleasant Hill Wrestling Club, K- 8th grade, is a self-funded program that relies solely on registration fees, donations, fundraising and volunteered time to operate. The coaching staff, board members and tournament assistants (exception of paid officials) are all volunteered positions to keep registration fees affordable for families. As a parent I understand that by volunteering I will contribute to the goal of developing young respectful athletes and the growth of the Pleasant Hill Wrestling Club. I will attend Club tournament planning meetings and or contact the coaching staff/board member to see how I can volunteer.
Name

First NameLast Name
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Select Registration Type
Select Payment Method:

Select type here if paying by credit card. If paying by cash or check skip this section and go directly to submit.

Middle School

5th - 8th Grade

$153.00

Little Billies

Kindergarten - 4th Grade. Note: Must be 5 year old as of Nov 10, 2026

$78.00

Enter coupon

Total

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Pleasant Hill Wrestling Club 26-27

Select type here if paying by credit card. If paying by cash or check skip this section and go directly to submit.

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