2010 Foundation Wrestling Camp Registration Form: Step 1 of 2

Note: After submitting this form, you will be redirected to a payment page. You must pay the camp fee in order to reserve your place at camp.

All fields marked with a * are required:

Camp Location and Date*
Wrestler Name*
Parents Names*
Street Address*
City*
State*
Zip*
Home Phone*
Parents Work Phone*
Parents Cell Phone
Email*
Confirm Email*
T Shirt Size*
Age at Camp*
Height*
Weight*
Insurance Company*
Policy Number
Insurance Phone Number
Medical Release
 By typing my name to the right, I confirm that my son/daughter has been examined by a physician in the last year and is in good health. I hereby authorize the Takedown Machine Staff and Purler Wrestling, Inc. to act for me, according to its best judgment in any medical emergency, and I herby waive and release Purler Wrestling, Inc. from any liability for injuries or illness incurred by my son/daughter while attending camp. All information I have provided on this application is true and correct. *