Nucla, Colorado Will 2 Win Wrestling Camp Registration Form printable pdf download

Nucla, Colorado Will 2 Win Wrestling Camp Registration Form

This registration form must be returned with FULL registration fee prior to receiving your confirmation letter. Make Money

Orders/cashiers checks Payable to: Michael Bostwick. Send to: Will 2 Win Wrestling LLC, Attn: Michael Bostwick, 5103 N.

191

Dr, Litchfield Park, AZ 85340

Name of Parent/Guardian:____________________________________________________________________

Name of Camper: ___________________________________________________________________________

Address: __________________________________________________________________________________

City:_________________________ State:__________________________ Zip______________

Home Phone:________________________ Cell Phone:_________________________________

Email Address of Camper: ________________________________________________________

Email Address of Parent/Guardian: _________________________________________________

Emergency Contact:___________________________________Phone:_____________________

School: _________________________________ Age (must be over 10 years old)____________

Grade: ______________________ Years of Wrestling Experience: ________________________

Medical Insurance Company:_____________________________________Phone _______________________

Medical Insurance Policy #:_____________________Group # (if applicable):___________________________

Policy Holder:_____________________________________________________________________________

Please attach a copy of your medical insurance card.

Please list any pre-existing medical conditions, including allergies, as well as medications the camper will be

taking during the camp.

I agree to allow my child to be treated by a licensed physician or registered nurse at the camp or licensed facility, if need be while attending the Will 2

Win Wrestling Camp and to assume all costs related to such treatment. I understand that there is no refund on the registration fee if we (parent or child)

should cancel the application at any time. I have read and agree to the terms associated with the camp flyer and information sheets. I hereby waive

my right to any and all chargebacks against the Will 2 Win Wrestling Camp as outlined in the agreement. I understand that the camper attending the

Will 2 Win Camp using any camp facilities, does so at his/her own risk. The host school district, its athletic department and staff are not liable for any

damages arising from personal injury sustained by the camper during the camp session and so I hereby fully and forever exonerate and discharge the

school district, staff, Nucla Junior and Senior High School, employees and other agents from any and all claims, demands, damages, right of action or

causes of action, present or future, whether the same be known, anticipated or unanticipated, resulting from or arising out of the camper’s participation

in the camp session and in the use of facilities.

I have read and understand the medical and liability release and I will be responsible for any medical or other charges in

connection with my child’s attendance at the Will 2 Win Wrestling Camp.

Parent or Legal Guardian Signature:______________________________________ Date: _________________