Athlete's Name  
Age Sex Weight Lbs   Height    Grade   State  
Athlete's complete E-mail (where program is to be Sent)

Consenting Parent's Name if Registering an Under 18 yrs of Age Youth
Name
Email Address

Sport:
 Wrestling

Experience
Beginner          
Intermediate    
Advanced        
Elite                  

Physical Readiness Test:
These Questions Must be Answered Negatively Before Beginning a New Exercise Program
1.   Has your doctor ever said you have heart trouble?
2.   Do you frequently have pains in your heart or chest?
3.   Do you feel faint or have spells of severe dizziness?
4.  Has your doctor ever said your blood pressure was too high?
5. Has your doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated by exercise or might be made worse with exercise?
6. Is there a good reason not mentioned above why you should not follow a vigorous conditioning program even if you wanted to? Heart Disease, Epilepsy, Arthritis, Back or Neck Injury, Past Surgeries, Knee Pain, Shoulder Pain, Ligament, Joint, Tendon Or Muscular Problem, Family History of anyone with Heart Disease over the age the age of 60.
7 Are you over age 60 and not accustomed to vigorous exercise?

If you have answered YES to any of the 7 PAR-Q Questions above It is advised that you see your physician before engaging in any new exercise program. 

MEDICAL HISTORY: Please discuss any medical conditions that would be 
important to know relating to designing, implementing and evaluating your individualized vigorous conditioning program: (i.e., low back pain, current illness, diabetes, high blood pressure, cartilage tear, previous injuries, any medications, etc). Check with your physician before beginning any new exercise program.


Discuss Your Sport Specific Goals:


Access to Strength Training & Cardio Equipment:
Health Club
Home Gym Equipment (d-bells, bench, mat, multi-station machine etc)
If Yes Please Describe in Detail: