Filter Type:
REGISTRATION FORM
for Covington, WA
Wrestling Camps/Clinics
(all fields required)
Name:
Email:
Address
City/State/Zip
Parents Name(s)
Home Phone
Parents Contact Phone
Grade Entering
T-Shirt Size
Male/Female
School
Coaches Name
Coaches Phone
USA Wrestling Member?
USA Wrestling Member No.
Rep Code (optional)
Camp
Camper/Commuter
AS A CONDITION OF ENROLLMENT, THE Medical Authorization, Disclaimer of Liability AND Medical Information Statement MUST BE SIGNED AND DATED BY THE CAMPER'S PARENTS OR GUARDIANS.
 
 Medical Authorization: In the event of an emergency, I hereby give permission for my child to be examined by the Camp Trainer and/or placed in the medical care of the licensed physicians selected by the Camp Operator. I understand that medical care shall include, but not be limited to, any decision to hospitalize and/or secure proper treatment, anesthesia or surgery necessary for the treatment of my child in said emergency.  US Camps is permitted to release any and all insurance information I have provided to them should my child require medical care. 
Health Insurance Co.
Contract or Group #


Disclaimer of Liability: US Camps, the Michigan Wrestling Camp (MWC), and its staff do not assume liability for any injuries incurred while at camp or on the way to or from camp. Parents should contact their own insurance carrier to get additional insurance for the camper, if necessary.  The Camper, in attending any US Camps/MWC and in using any of our facilities, does so at his own risk. US Camps/MWC and their staff; shall not be liable for any damages arising from personal injuries sustained by the camper during the clinic or at the facilities. The camper and his parents assume full responsibility for any damages or injuries which may occur to the camper during the clinic session and so hereby fully and forever exonerate and discharge US Camps/MWC, its staff, its owners, employees, and agents from any and all claims, demands, rights of action or causes of action, present or future, anticipated or unanticipated, resulting from or arising out of the camper's participation in the clinic session and in the use of the facilities.
 
Medical Information Statement: As a condition to participation in US Camps/MWC, I understand that each participant must have had a physical checkup by a certified physician within the last calendar year. My child has had a physical within the last year and has been declared healthy and able to participate in clinic activities.
 
BY ENTERING YOUR INITIALS IN THE BOX BELOW, YOU HEREBY STATE YOUR UNDERSTANDING, ACCEPTANCE OF AND AGREEMENT TO THE Medical Authorization, Disclaimer of Liability, and Medical Information Statement.
Initials of Parent or Guardian


Date


ONCE YOU HAVE SUBMITTED THIS FORM YOU WILL BE REDIRECTED TO A SECURE SERVER TO PROVIDE PAYMENT INFORMATION AND COMPLETE YOUR REGISTRATION. 
*** Please note you are NOT registered ***
 until payment has been received by US Camps.
 
Click "Submit" to proceed 
Credit Card, Checks, and Money orders are accepted
 
Thanks from US Camps -
see you at the 2009 Covington, WA Camp
where you'll LEARN FROM THE BEST!

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For more information:
US Camps
8320 Russett Court
Colorado Springs, CO 80919 US
Email: info@uscamps.net
719-531-6540

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