MOTOR CITY WRESTLING CLUB

18300 19 MILE ROAD, CLINTON TWP., MI 48038

RELEASE #2 *

APPROXIMATE WEIGHT *

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RELEASE #1 *

EMERGENCY CONTACT -2- *

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ADDRESS *

RELEASE #3 *

PARENT / GUARDIAN -1- *

ATHLETE'S NAME: *

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STEP 3

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EMERGENCY CONTACT -1- *

YEARS WRESTLING

BIRTH CERTIFICATE

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MEDICAL CERTIFICATION *

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