All American Wrestling Camp

Rob Waller's All American Wrestling Camp

North Star High School Gymnasium - 400 Ohio Street, Boswell, PA 15531
Athlete Information
Wrestler Name*

First NameLast Name
Wrestler Age
Date of Birth
Wrestler Weight
School District/Wrestling Club
Guardian / Parent Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone
E-mail
example@example.com
Permission to Treat - Coach Waller and/or his designees have permission to treat you participant if necessary, at the appropriate facility if they are injured, or if they appear to be injured.*

YesNo
Indemnification by Parent or Guardian of Applicant - The undersigned guardian of the participant, for and in further consideration of the wrestling camp accepting said applicant does hereby release and discharge North Star School District, North Star Wrestling Club, the curators of Rob Wallers All-American Wrestling Club/Camp and it's representatives, employees and agents from any and all debts, claims and demands, actions, damages, causes of action, judgments or suits of any kind which may result of this applicant participation in, traveling to or from the All-American Wrestling Club/Camp, and hereby agree to have and indemnify and keep harmless North Star School District, North Star Wrestling Club, the curators of the All-American Wrestling Camps, it's representatives, employees and agents against liability claims, judgments or demands for damages arising as a result of any course instruction given the applicant by Coach Waller or any designee of Rob Waller's All-American Wrestling Club/Camps.*

YesNo
Type Guardian's Name to Represent Signature*
Date*
Registration fee is due by the first day of camp - July 15th. The fee for the camp is $150.00 in the form of cash/check. Please make checks payable to "North Star Wrestling Boosters". You can make prior arrangements for payment by contacting Caitlin Fleegle - 814-442-4860. We look forward to seeing you!
Should be Empty:

Rob Waller's All American Wrestling Camp