Print NAME: _____________________________________ AGE: ________ WEIGHT: ___________

GRADE ENTERING NEXT SEPTEMBER: __________

ADDRESS: ____________________________________________________________

CITY: _______________________________ STATE: _________ ZIP: ___________________

PHONE NUMBER: __________________________________       CELL PHONE NUMBER: __________________________________

SCHOOL NAME: ____________________________________________________________________

I Wish To Enroll In (Circle):    Week 1    or    Week 2    or    Both Week 1 & Week 2

I Will Be Attending the Following Camp (Circle):    Train with Olympians HS Camp    or    Middle School Technique Camp     or

                                                                         Half Day Youth Camp    or    Full Day Youth Camp

I Hereby Give My Son _________________________, Permission To Participate & Compete In The Sachem Three-Style Wrestling Camp. I Assume Full Responsibility & Liability For Any And All Injuries My Son May Sustain During Camp. I Understand That In The Event Of An Accident Or Injury, Only Emergency Medical Care Will Be Provided & I Hereby Authorize The Rendering Of Such Medical Care As May Be Required.

___________________________________________ Signature of Parent or Guardian

FAMILY E-MAIL ADDRESS: ___________________________________________________________________

A $25.00 Non-Refundable Deposit, Payable To Sachem Wrestling Club Must Accompany This Registration Form. If Additional Forms Are Required, This Form May Be Copied.

USA Wrestling Card Number: ______________________________
for Insurance Purposes

CAMP SITE
SACHEM NORTH HIGH SCHOOL

PRINTED FROM LongIslandWrestling,org