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South Bakersfield Wrestling

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Child's Name

Name
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Parent Information

Name
Address

Emergency Contact #1

Name

Emergency Contact #2

Name

Parents' Instructions on Medical Treatments

Wrestler's Name
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Parent/Guardian Name
Address

Please Indicate another person to call if an accident occurs and we are unable to reach you

Name
Family Doctor Name
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if this is more than a year ago, then you will be required to complete a medical history questionnaire

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Rebel Wrestling Club

South High School

1101 Planz Road
Bakersfield, CA 93304

contact@rebelwrestling.org