Registration

Northwest Registration at Centennial Highschool is open.

Use button below to register today!

Class Registration Form

Athlete Name

First Name

Last Name

Is your athlete a current Gold Rush Member

A MEMBER: An athlete who is been active in any one of our programs over the last year.

Year Athlete was Born

Athlete USA Card Number (N/A) if no USA Card

USA Card Renewal is August 21st

Years of Wrestling Experience

Athlete T-Shirt Size

Specify Youth or Adult

Do you plan on having your athlete travel this year

Yes

No

List Any Important Medical Issues

For Internal Staff Use Only

If athlete has a medical condition requiring an inhaler, epipen, etc. where will the medical device be located during practice

For Internal Use Only

Health Insurance Carrier

Health Insurance Number

#1 Parent Contact Name

First Name

Last Name

#1 Parent Contact Phone Number

Country

(###)

###

####

Email

#2 Parent Contact Name

This is for Emergency Purposes

#2 Parent Contact Number

This is for Emergency Purposes

Country

(###)

###

####

What do you hope your athlete gets out of Gold Rush

Register into Class Below

Practice Days: Monday, Tuesday, Thursday at 6;30

Payment Method

NOTE: There will be $2.79 transaction applied to CC Payments. CC Fee Schedule below Monthly: Friday August 30th Tuesday October 1st Paid in Full: Friday August 30th

Cash

CC on File

New CC on File

Check

Please note this is a two month commitment.

*** You are entering into a 2 month contract. Please pay attention to the cancellation policy below. If you pay up front, $50 termination fee before you receive 1/2 of the remaining money back. If you pay monthly, $50 termination fee + one month tuition.

Yes I agree