THE EAST SIDE GRAPPLING CLUB ATHLETE INFORMATION SHEET



Athlete’s name printed __________________________________



Participant or Parent/Guardian Signature (if 18 or under or still in High School or below)


____________________________________________Date signed____________



Allergic reactions to: ______________________________________________



Medications currently taking: _________________________________________________



Any past illnesses or other information that would be useful in the event medical treatment is necessary:



_______________________________________________________________



Information;


Parents or Legal Guardian _______________________________________________



Address _____________________________________________________________________
(Be sure to include zip and city if other than Lincoln)


Phone# __________________________ Cell phone #__________________________


Emergency Phone# ________________________ email address ________________________________



Insurance Company_________________________________ Policy #______________________



Age________ Grade ________