Registration form for Durango CO. Wrestling Camps/Clinics

Name:
Email:
Address
City/State/Zip
Parents Name(s)
Home Phone
Parents Work Phone
Grade Entering
T-Shirt Size
Male/Female
School
Coaches Name
Coaches Phone
Rep Code (optional)
Camp
Camper/Commuter

MEDICAL AUTHORlZATION:

Medical authorization: In an emergency, I hereby given permission for my child to be examined by the camp trainer. I also give permission to the license physicians selected by the camp operator to hospitalize, secure proper treatment, anesthesia, or surgery, for my child in an emergency.  I also give if can permission to advise the hospital of our insurance information at the time of any treatment.

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 As a condition of enrollment, the following disclaimer of liability must be signed and dated by the camper's parents.

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: as a condition participation in US Camps/MWC, 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, I agree to the above Medical authorization, disclaimer of liability, and medical information statements.
Initials of Parent or Guardian


Date


When you submit this form you will be redirected to a secure server to place your order. 
Please note you will NOT be registered until payment has been received.
 
Click Submit to proceed to Order Form, 
Credit Card, Checks, and Money orders are accepted.

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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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