Your Junior Grappler's Information

First, please provide your Junior Grappler's information:

Your Junior Grappler's First Name

Your Junior Grappler's Last Name

Your Junior Grappler's Birth Date (MM/DD/YYYY)

Your Information

Next, please provide your information, as parent or guardian:

Parent or Guardian First Name

Parent or Guardian Last Name

Parent or Guardian E-mail

Parent or Guardian Telephone

Parent or Guardian Address (line 1)

Parent or Guardian Address (line 2 - apartment number)

Parent or Guardian City

Parent or Guardian State

Parent or Guardian Zip Code

Emergency Contact Information

Next, please provide your emergency contact information.

Emergency Contact Name

Emergency Contact Phone

Emergency Contact Email

Terms and Conditions

Finally, please accept the terms below and verify that you are under 18 years old.

I accept the terms of the PPW Activity Waiver
I accept the terms of the PPW Media Release
I consent to a background check, if needed
I am under 18 years old

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Personal Information

First, please provide your personal information:

Your First Name

Your Last Name

Your E-mail

Your Telephone

Your Address (line 1)

Your Address (line 2 - apartment number)

Your City

Your State

Your Zip Code

Emergency Contact Information

Next, please provide your emergency contact information.

Emergency Contact Name

Emergency Contact Phone

Emergency Contact Email

Terms and Conditions

Finally, please accept the terms below and verify that you are 18 years old, or older.

I accept the terms of the PPW Activity Waiver
I accept the terms of the PPW Media Release
I consent to a background check, if needed
I am 18 years old, or older

Δ