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    2015 Camp Registration

    Uploaded by

    Bobby
    This document provides information about a wrestling camp to be held from July 27-30, 2015 at Leonardtown High School. It includes a registration form requesting personal details such as name, address, emergency contact, and medical insurance information. It also includes authorizations for medical treatment if needed and a liability waiver releasing the school and organizers from responsibility for injuries. The cost of the camp is $150 with a $50 non-refundable deposit required at registration.

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    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd

    2015 Camp Registration

    Uploaded by

    Bobby
    9 views1 page
    This document provides information about a wrestling camp to be held from July 27-30, 2015 at Leonardtown High School. It includes a registration form requesting personal details such as name, address, emergency contact, and medical insurance information. It also includes authorizations for medical treatment if needed and a liability waiver releasing the school and organizers from responsibility for injuries. The cost of the camp is $150 with a $50 non-refundable deposit required at registration.

    Original Description:

    Registration form for 2015 Wrestling Camp at Leonardtown High School.

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    This document provides information about a wrestling camp to be held from July 27-30, 2015 at Leonardtown High School. It includes a registration form requesting personal details such as name, address, emergency contact, and medical insurance information. It also includes authorizations for medical treatment if needed and a liability waiver releasing the school and organizers from responsibility for injuries. The cost of the camp is $150 with a $50 non-refundable deposit required at registration.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    9 views1 page

    2015 Camp Registration

    Uploaded by

    Bobby
    This document provides information about a wrestling camp to be held from July 27-30, 2015 at Leonardtown High School. It includes a registration form requesting personal details such as name, address, emergency contact, and medical insurance information. It also includes authorizations for medical treatment if needed and a liability waiver releasing the school and organizers from responsibility for injuries. The cost of the camp is $150 with a $50 non-refundable deposit required at registration.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 1

    Championship Takedowns

    Wrestling Camp
    @
    Leonardtown High School
    Monday July 27, 2015 Thursday July 30, 2015
    (9:00AM 4:00PM)
    Last Name_______________________First Name______________________Middle___
    Address_________________________________________________________________
    City____________________________State_________Zip_________Phone__________
    Date of Birth__________________________________
    E-Mail Address:__________________________________________________________
    In Case of Emergency:

    Name_______________________Relationship__________
    Address_________________________________________
    City____________________State______Zip___________
    Phone__________________(W)___________________(H)

    Medical Insurance Company________________________Policy #__________________


    Subscribers Name________________________________
    Medical Treatment Authorization: I hereby authorize the clinical staff and the local
    emergency medical responders to provide care and medical treatment as necessary to my
    son/daughter ________________________. I understand that the consent and
    authorization herein granted do not include major surgical procedures and are only valid
    during camp. In the event that an illness or injury would require more extensive
    evaluation, I understand that every reasonable attempt will be made to contact me.
    However, in the event of an emergency, and if I cannot be reached, I give my consent for
    clinicians and staff at Leonardtown High School to arrange necessary emergency
    treatments. Each participant must have had a physical checkup by a certified physician
    within the past year. My son/daughter has had a physical within the last year and has been
    declared healthy and able to participate in clinic activities.
    I the undersigned, individually and as a parent and or guardian of
    ______________________, a minor, ask that he/she be admitted to participate in this
    sports camp. I do hereby agree to release, discharge, and hold harmless Southern
    Maryland Wrestling Club, St. Marys Wrestling Club, Leonardtown High School,
    Leonardtown High School officers, agents and employees of and from all causes,
    liabilities damages, claims, or demands whatsoever on account of any injury or accident
    involving said minor arising out of minors attendance and participation at this sports
    camp.
    Signature: _____________________________

    Date: ______________________

    Cost: $150 ($50 non-refundable deposit due at time of registration, balance due 1st day of camp)
    Please make checks payable: St. Marys Wrestling

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