Which camp session are you interested in? ---Choose a Camp--- Week 1 June 9 – 13 Week 2 June 15 – 19 Week 3 June 21 – 25 Week 4 June 28 – JUly 2 Week 5 July 5 – July 9 Week 6 July 12 – July 16

Tell us who will be attending:

Wrestler's Name
Address
City
State
Zip
Parent's Name('s)
E-mail
Home Phone
Emergency Phone
Work Phone
T-Shirt Size	--Choose One-- Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL
Current Weight
Current Height:
Age
Medical Insurance Co.
Policy #
The medical waiver is required before registration can be accepted.	Waiver My son/daughter has been examined by a physician in the last year and is in good health.  I hereby authorize the Takedown Machine Camp Staff to act for me, according to it’s best judgment in any medical emergency, and I hereby waive and release the Takedown Machine staff from any liability for injuries or illness incurred by my son/daughter while attending camp.  All information I have provided on this application is accurate. By checking this box you acknowledge and agree to this medical waiver and that you are over 18 years of age.

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