2023 AZ-USAW 16U Dual Team Registration
Step 1 of 3: Submit
Participant First Name
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Participant Last Name
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Participant Age (Please Select Appropriate Age)
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Select an option:
14
15
16
USA Wrestling Card Number
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Tshirt Size
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Select an option:
Youth Lrg
Adult SM
Adult Med
Adult Lrg
Adult XL
Adult 2XL
Shorts Size
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Select an option:
Youth Lrg
Adult SM
Adult Med
Adult Lrg
Adult XL
Adult 2XL
Singlet Size
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Select an option:
Youth Lrg
SM
Med
Lrg
XL
2XL
Parent/Guardian #1 First Name
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Parent/Guardian #1 Last Name
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Parent/Guardian #1 Phone
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Parent/Guardian #1 Email
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Parent/Guardian #2 First Name
Parent/Guardian #2 Last Name
Parent/Guardian #2 Phone
Parent/Guardian #2 Email
Emergency Contact First Name
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Emergency Contact Last Name
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Emergency Contact Phone Number
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Does Participant Have Any Allergies We Need To Be Aware Of?
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YES
NO
If Yes, Please List Allergies
Does Participant Have Any Other Medical Conditions We Need To Be Aware Of?
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YES
NO
If Yes, Please List Medical Conditions
Medical Insurance Company
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Medical Insurance Policy Holder
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Medical Insurance Phone Number
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Medical Insurance Policy Number
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Medical Insurance Group Number
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In case of injury, may coaches/administrators seek closest hospital for immediate care?
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Select an option:
YES
NO
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I have read Waiver of Liability and acknowledge
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Registration Payment (1st Payment)
Registration Fee
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Select an option:
16U National Dual Team Pay-In Full ($800 USD)
16U National Dual Team First Payment Due by May 12th (2nd Payment Due on May 29th) ($400 USD)
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