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The NCWA Wrestler Registration Form

Wrestler Bio:
School: School Code:
Required: Get this from your Coach, Your registration will not go through without this Code
Wrestler's First Name: Wrestler's Last Name:
Current Age: Date of Birth:
Wrestler's Current Academic Status (check one): Freshman Sophomore
Junior Senior
Graduate
Expected Weight Class:
Wrestler's Personal e-mail Address: jim@hotmail.com
Wrestler's School e-mail Address: jim@pennstate.edu
Wrestler's Home Phone #: (555) 555-5555
Wrestler's Cell / Alternate Phone #: (555) 555-5555
High School Competition Background:
High School:
City/State:
High School Graduation Year: 1996
High School Career Record: Highest State Place:
Collegiate Competition Background:
Month/Year first entered Any college/university: 06/96
I competed in the NCWA during: 1997,1998,1999
1st Year:

Checkboxes or text Required
Prior College Competition in other Association(s): (check all that apply) NONE: NCAA:
NAIA: NJCAA:
Former College name and City/State:
If applicable
Emergency Contact Info:
Name:Emergency Phone #:
Emergency Email:
Relationship:Emergency Contact Address: (address city,state zip)
Wrestling Plan Acknowledgment:
I, the undersigned, do hereby acknowledge that I have read, with understanding, the current edition of the NCWA Wrestling Plan, and I agree to abide by all of the articles of the Plan. Wrestling Plan
Wrestler's Acknowledgment: Yes I Agree
NO I Reject
Wrestler Waiver and Release of Liability Acknowledgment:
I, the undersigned, do hereby acknowledge that I have read, Understood and Agree to the "Wrestler Waiver and Release of Liability" (WWRL). I agree to abide in spirit and in law by all of the tenants included in the WWRL. View the form before agreeing. Review Waver/Liability Form
Wrestler's Acknowledgment: Yes I Agree
NO I Reject
Wrestler's Insurance Acknowledgment:
It is understood that All wrestlers must carry some type of medical insurance before registering with the NCWA as a participant. Individuals may carry health insurance through their parents, their school, or have a personal injury policy. The NCWA, as an organizational body, cannot accept any liability for athletes during practice, travel and/or competition. Every athlete must sign this acknowledgement concerning the above policy before practicing or competing in any NCWA activity.
Wrestler's Acknowledgment: Yes I Agree
NO I Reject
Health Insurance Information:
Proof of Insurance is Required
Carrier:Policy #:
Eligibility Acknowledgement:
Coach's Name Printed:
Coach's Signature:___________________________________
Administrator's Name Printed:
Administrator's Signature:___________________________________
Wrestler's Name Printed:
Wrestler's Signature:___________________________________