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INDIANA WRESTLING CAMPS

2018-19 INDIANA WRESTLING SHENANDOAH IN-SEASON camp SERIES

Dec. 17, Jan. 7, Jan. 14, Jan. 21
5-6:30 p.m.

CAMP COSTS

$10.00*

CAMP location

Shenandoah High School
7354 US-36
Middletown, IN 47356

Enter at Door #7

ADDITIONAL INFORMATION

E-Mail: Click Here!
Phone: 812-219-8780
Register On-Line: Now Available!
All Camps open to any and all entrants

2018-19 Shenandoah H.S. In-Season Camp Series

Registration Note: Registrations will be accepted until camp is full. No refunds for cancellations.
 
Which session(s) will you be attending (check all that apply)  

 All Four Sessions (Dec. 17, Jan. 7, Jan. 14, Jan. 21)  

 Dec. 17 Only  

 Jan. 7 Only  

 Jan. 14 Only  

 Jan. 21 Only  

Camper's Name (Last, First)*
 
Home Address*
 
City*
 
State*
 
Zip*
 
Camper's Home Phone #*
 
Parent/Guardian Name(s)*
 
Parent's E-Mail Address*
 
Parent's Cell Phone #
 
Age*
 
H.S. Graduation Year (i.e. 2020)*
 
Birthdate (Month/Day/Year)*
 
Camper's School*
 
Height (i.e. 5'9")*
 
Weight*
 

MEDICAL CONSENT FORM
To enable local health providers and/or other health facilities to provide prompt care to your son, we must have a completed Consent Form on file each year. This way, we can help your child without delay in an emergency.
 
Name of Minor*
 
Insurance Company*
 
Policy Number/Group #*
 
Name of Policy Holder*
 
Present Medication (include dosage)
 
Any allergies or allergic reactions our medical staff should be aware of?
 
If the camper should be restricted from any activity, please note
 
Date of Last Tetanus Toxoid
 
Any Past Illness, injury, or other information that would be useful in the event of medical treatment
 
Name and Phone Number to call if parents cannot be reached*
 

* I grant permission to the Directors, Assistants, or other persons responsible for her care to act on my behalf of said minor in granting permission for evaluation and treatment of medical problems. I understand that should a major medical problem arise, an attempt will be made to notify me by telephone. In the event that I cannot be reached, I hereby give consent to such medical treatment as deemed necessary including surgery, x-ray examinations and anesthesia to be rendered to said minor by a licensed physician or nurse.  

* Waiver: In consideration of being allowed to participate in the Angel Escobedo Wrestling Camps, I, for myself, my heirs, personal representatives or assigns, do hereby release, waive, discharge and covenant not to sue Angel Escobedo Wrestling Camps and Forward Marketing LLC, their officers, employees and agents for liability from any and all claims including the negligence of the Angel Escobedo Wrestling Camps, its officers, employees and agents, resulting in personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to, participation in the Angel Escobedo Wrestling Camps.  

* By my submission of this registration, I represent that I am either 18 years of age or older, or that I am the parent or legal guardian of the registrant (if he/she is under age 18). I represent I have read the terms of the Privacy Policy, that I understand the manner in which the information collected about the registrant may be used, and that I agree to the use of the registrant’s personally identifiable information in the manner described in the Privacy Policy.  

Parent/Guardian Name*
 
Date*
 

PAYMENT OPTIONS
Please select your payment option by indicating a '1' in the quantity field.
We need a registration form and consents completed for each participant.

Note: A charge from Hoosiersportscamps.com will appear on your credit card for your on-line registration. However, if any of the Angel Escobedo Wrestling Camps are canceled for any reason, refunds must be collected directly from Angel Escobedo Wrestling Camps.
 
Qty 
 $31.80 Option 1 - All Four Sessions (enter a 1 in the box if selecting this option)

 $10.60 Option 2 - Single Session Rate (enter a the number of sessions you are attending, 1-3, in the box if selecting this option)