2011-2012 Registration Form
Name: ____________________________________________ Boy ___ / Girl ___
Birth date: _____/_____/_____ Age_________ Weight: __________ lbs Grade: _________
Address: _______________________________________ Home Phone: ______-__________
Town: ____________________ State: ______ Zip: _______ Cell: (______) _______-_________
Alt Cell: (______) _______-_________
Parents’ e-mail address: ___________________________________________
Alternate e-mail address: ___________________________________________
Emergency Contact Name: _________________________________ Phone: (_____)_____-__________
Please circle one: Please note your child must live within the Hackettstown High School sending district or we are
unable to register your child with our program.
Willow Grove (K-4) Hatchery Hill (K-4) Hackettstown Middle (5-8) Central (K-5)
Liberty (K-5) Great Meadows Middle (6-8) St. Mary’s (K-8) Allamuchy (K-8)
Have you wrestled before_______________ Clinic / JV / V Years of Experience______ (2+ yrs considered JV)
Does your child have any medical problems the coaches should know about?
I hereby consent to my child’s participation in the Tiger Wrestling Club’s program. I agree to indemnify and hold free and
harmless the Hackettstown Recreation Commission, the Tiger Wrestling Club, its officers, coaches and officials from any and all
liability against them arising out of my child’s participation therein, whether liability is caused by, or arose out of negligence. I
understand that the Hackettstown, Independence, and Liberty Recreation commissions only sponsor the TWC, and are not
affiliated with, and are not responsible for, any possible accidents arising from my child’s participation. The Hackettstown
Recreation Commission does not provide medical insurance for the participants, nor liability coverage for any accidents that may
occur to or from out of town matches. TWC provides secondary medical coverage.
Please provide your insurance carrier: ______________________________________ Policy # __________________
Signature of parent or guardian: ____________________________________ Date ___________________
Print parents name(s): _______________________________________________________________________
Make checks payable to TWC: * All return checks will incur additional bank fees *
Novice: (Free TWC T-shirt included)
In town: $60 single; $85 for Novice family (more than one child in Novice)
Out of town: $75 single; $100 for Novice family (more than one child in Novice)
Shirt Size: YS_____YM_____YL_____AS_____AM_____AL_____
JV/Varsity: (Free TWC T-shirt and shorts included)
In town: $75 single; $110 for Varsity family (Novice, JV & Varsity wrestlers)
Out of town: $90 single; $125 for Varsity family (Novice, JV & Varsity wrestlers)
Shirt Size: YS_____YM_____YL_____AS_____AM_____AL_____ AXL_____ AXXL_____
Short Size: YS_____YM_____YL_____AS_____AM_____AL_____ AXL_____ AXXL_____
Additional tiger-wear will be available for purchase
TWC use only: Check # ______ _ Amount ____________ or Cash __________
Media Form
Parent Consent Form
During the course of our wrestling season many of our parents take
photographs of wresting matches, trophy wins and other special honors
during the season. We wish to place some of these pictures on our web
site tigerwrestlingclub.com
Before placing a photo of your child on our web site, we would like to
ask your permission to allow your childs photo to appear on our web
site. Please read the follow choices carefully and identify the course of
action you would like us to follow regarding your child below.
Wrestlers Name______________________________
o I grant permission for a photo that includes my child with his/her
name to be published on the Internet.
o I grant my permission for a photo that includes my child without
his/her name to be published on the Internet.
o I do not grant permission for a photo that includes my child
without his/her name to be published on the Internet.
Parent/. Signature_____________________________
Date______________________