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# __________________________


Emergency Phone# ________________________


Insurance Company_________________________________ Policy #______________________



Age________ Grade ________