Registration With Fundunding

PARENT/GUARDIAN INFORMATION

**At least one parent MUST be filled in if the participant is under 18 years. **

Parent/Guardian 1(Required)

First Name Last Name

Relationship to Student(Required)

Cell Phone 1(Required)

Parent/Guardian Email 1(Required)

This email will be used for payment receipts and WAMMA communications.

Parent/Guardian 2

First Name Last Name

Relationship to Student

Cell Phone 2

Parent/Guardian Email 2

Would you like to receive email notifications from WAMMA NextGen?(Required)

YES

NO

We will communicate via email when there are announcements, unexpected closures, promotions, event news and other WAMMA related information.

PARTICIPANT "Member" INFORMATION

Name(Required)

Student First Name Student Last Name

Gender Identity(Required)

Male

Female

Rather not say

Other

Birth Date(Required)

Age(Required)

Address(Required)

Street Address City Province Postal Code

Student's Cell Phone

Home Phone

Student's Email

If different than parent's email

MEDICAL/EMERGENCY INFORMATION

Medical Conditions/Allergies

MB Health Number (6-digit)(Required)

Personal Health Number (9-digit)(Required)

EMERGENCY CONTACT INFORMATION(Required)

First Last

In case of an emergency, we will attempt to contact this person if a parent/guardian is unavailable.

Emergency Contact Number(Required)

Relationship to Student(Required)

This field is hidden when viewing the form

After your registration, you will be asked to register with our local wrestling association for insurance purposes. This is a yearly requirement. The cost varies between $30 and $100 based on age group and other factors. Link will be provided.(Required)

I understand

Terms and Conditions

Photo Consent and Release

I give WAMMA Canada my consent to use any photographs, videos or images of myself/child for use in its publications, advertising or other media activities (including the internet) for the purpose of promoting WAMMA NextGen programming.(Required)

YES

NO

Payment

Product Name

Total

This is the monthly membership amount including GST based on the number of CLASSES per week the student will attend. Invoices may be provided to the funding organization for amounts covering several months.

Please give us more information about the organization you will be requesting funding.

Name of organization membership fees will be paid by. What you are requesting funding for (membership fees, number of months, gear and equipment, etc)?