TDM Camp Registration Form

Medical Release*
By typing my name in the box to the right, I agree 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.

Camp Attending*
Camper's Name*
Parents' Names*
E-Mail*
Confirm E-Mail*
Home Address (Street Address, State, and Zip) *
Home Phone and Cell Phone*
Age at Camp*
Estimated Weight*
Estimated Height*
T-Shirt Size*
Health Insurance Company*
Policy Number
Comments
Medical Release* By typing my name in the box to the right, I agree 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.
Will your child need airport transportation* If yes, please contact Jackie at jackie@purlerwrestling.com for scheduling and pricing
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