Great Camp Opportunity at CV High School

ROBERTS WRESTLING CAMPS

Presents….

Great Camp Opportunity at CV High School

June 22-24, 2018

2x NCAA All American, Kevin Roberts

3x NCAA Champion, Chad Lamer

And more to come…..

Individual Wrestler: $125

Teams of 6+: $100 per wrestler

Entire Team: $1000

This is a commuter camp. We will have snacks and drinks available. Please make payment and send registration soon. Your spot will then be held in the event of camp reaching full capacity. We can do our best to assist with housing individuals, but we must know sooner rather than later of your intention to attend!! Please email me for a registration form, medical release and payment information!! No wrestler will be allowed to participate without the proper forms submitted to the camp. Contact me at: #RobertsWrestling

INSURANCE INFORMATION & PARENT/GUARDIAN RELEASE FORM

Note: Please print legibly in INK or type. This form must be completed in FULL, including signatures of parent or legal guardian. Campers will NOT BE ALLOWED to participate without completion of this form. Separate forms are needed for each camp.

Campers Name______

Date of Birth______

Name of Camp______

Dates of Camp______

MEDICAL INFORMATION

Any known Allergies, Illnesses, Injuries, or Disabilities______

Medications Camper will bring______

Participant’s Physician Name______

Physician Address______

Date of last Tetanus Booster______

INSURANCE INFORMATION

Insurance Company Name______

Phone number______

Policy Holder’s Name______

Policy Number______

Group Number______

EMERGENCY INFORMATION

Emergency Contact #1 Name______Relationship______

Home Number______WorkNumber______Cell Number______

Emergency Contact #2 Name______Relationship______

Home Number______WorkNumber______Cell Number______

PARENT/GUARDIAN RELEASE

I hereby:

1. Give permission to the above name camper to attend and participate in the Roberts Wrestling, LLC referenced above.

2. Give permission to the staff to render preventative, first aid or emergency treatment, or all the foregoing , necessary to camper’s

health and well-being. In the event of serious injury/illness, the need for major surgery, or significant accidental injury, I understand

an attempt will be made by the camp staff to notify the designated emergency contacts as soon as possible. If camp staff is unable to communicate with me, the treatment deemed necessary for camper’s health and well being may be given.

3. Certify that, to the best of my knowledge, the medical information requested above is complete and correct, and that no health

related situations preclude camper’s participation in camp activities.

4. Agree to assume all risk arising from camper’s participation in camp activities, including but not limited to any activities that may

present risk of bodily injury.

5. Agree to waive, hold harmless, discharge and release Roberts Wrestling, LLC or the facilities they are using for any and all liability, claims, causes of action, damages or demands in connection with camper participation in camp activities including transportation to, at, or from camp activities.

6. Understand that any medical expenses for Camper’s health and well-being will be the responsibility of the parent/guardian.

Please complete forms and send payment to Roberts Wrestling, LLC.

29569 NE Pheasant Ave Corvallis, OR 97333