Wrestler's Name (required)
Which location do you plan to attend?SIUE EdwardsvilleOzark High SchoolHerrin High SchoolAuburn Elementary SchoolCarthage Junior High School
Home or Cell Phone (required)
Emergency Phone (required)
Wrestler's Current Height (required)
Wrestler's Current Weight(required)
Date of Birth (required)
Number of years experience (including this year - required)
Grade (including this year - required)
What school do you attend? (required)
Record this year (or last)
Do you plan to train year-round? (required)YesNo
If not, how many months per year will you train?
USA Wrestling Card or AAU Card # (Youth wrestlers only! You MUST have a valid USAW or AAU card to train at PWA. Click here to get your USAW card or here for your AAU Card. The USAW card is about $30 and the AAU is around $20. However, if you plan to compete in off-season tournaments or attend weekend clinics, you will need the USAW card so should purchase that one. I have separate high school insurance for PWA so high school kids do not need the cards. If you have one, please include number anyway. )
Check off the box below to accept the terms of the waiver and release:I fully understand that the Purler Wrestling, Inc. staff are not physicians or medical practitioners of any kind. With the above in mind, I hereby release the Purler Wrestling, Inc. staff to render temporary first aid to my child or children in the event of any injury or illness, and if deemed necessary by the Purler Wrestling, Inc. staff to call our doctor and to seek medical help, including transportation by a Purler Wrestling, Inc. staff member and / or its representatives, whether paid or volunteer, to any health care facility or hospital, or the calling of an ambulance for said child should the Purler Wrestling, Inc. staff deem this to be necessary.
In consideration of your acceptance of this entry, I intend to be legally bound hereby for myself, my heirs, executors and administrators waive and release PURLER WRESTLING, INC, THEIR AGENTS, REPRESENTATIVES, COACHES, VOLUNTEERS, FROM ANY AND ALL CLAIMS OR RIGHTS TO DAMAGE FOR INJURIES OR LOSSES SUFFERED BY ME DIRECTLY OR INDIRECTLY IN TRAINING OR TRAVELING TO OR FROM OR COMPETING IN, OR ATTENDING the training camp.
Check this box to accept the above terms of the waiver and release:
Enter the characters in the image into the box below