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VALLEY VIEW YOUTH WRESTLING
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Camp Registration
Wrestler's Name
Date of Birth
Email Address
Parent/Guardian Name
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Cell Number
Work Number
Home Number
Name of Primary Insurance Company
Secondary Name
Policy Number
Secondary Phone Number
Is your westler presently on medication?
If Yes, list medication(s) here
Drug Sensitivities
Other Allergies
Special Medical Conditions
Shirt Size
Shirt Size
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