ALL AMERICAN-SAVE WRESTLING CAMPAPPLICATION FORM

PLEASE PRINT LEGIBLY

PERSONAL INFORMATION

___________________________________________ ___ _____________________________________________FIRST NAME! ! ! ! M.I. LAST NAME

______________________________________________________________________________________________ADDRESS

____________________________________________________________________ _______ ________________CITY! ! ! ! ! ! ! ! ! ! STATE! ZIP CODE

__________-__________-__________! ! ! ! __________-__________-__________HOME PHONE! ! ! ! ! ! ! CELL PHONE

________/________/________! ! ! ________________________________________________DATE OF BIRTH (MM/DD/YY)!! ! E-MAIL ADDRESS

EMERGENCY CONTACT INFORMATION

_____________________________________________ _____ _________________________________________FIRST NAME ! ! ! ! ! ! ! M.I.! LAST NAME

_______-_______-_______ _________________________________________________________CELL PHONE/CONTACT PHONE! RELATIONSHIP TO PERSON REGISTERED ABOVE

______________________________________________________________________________________HEALTH INSURANCE COMPANY

______________________________________________________________________________________HEALTH INSURANCE POLICY OR GROUP NUMBER

______________________________________________________________________________________MEDICAL CONDITIONS (KNOWN ALLERGIES, MEDICATIONS, ETC.)

PAYMENT INFORMATION

EARLY REGISTRATION (before Aug 1st., 2013)_____$40 Both Days _____$25 One Day

T-Shirt Size (early registration only)YOUTH ___L ADULT ___S ___M ___L ___XL ___XXL

LATE REGISTRATION (Day of Camp)t-shirt may be available for purchase

(not guaranteed size)

PLEASE BRING THIS COMPLETED

FORM TO CAMP ON AUGUST 2ND AT

8:00 am

AWARENESS OF RISKBy participating in athletic activities there are possibilities of serious injuries and death. The staff working with the All American-Save Wrestling Camp are well qualified professional people. Safety will be the number one concern. It will continually be emphasized on and off the activity areas. The information contained below is to inform individuals in this program and their parents of proper techniques for maximum safety.RULES AND PROCEDURES1. Always follow prescribed warm up to prevent injuries.2. Always follow technique outlined by coaches. Do not attempt to improvise.3. If in doubt to any rules or to what you are doing ask your coach/instructor before preceding.

This report does not cover all potential injury possibilities in the camp, but it is an attempt to make the athletes and their parents aware that fundamentals, coaching, and proper use of equipment are important to their safety and enjoyment at the All American-Save Wrestling Camp.

By signing the line below, I hereby authorize the staff of the All American-Save Wrestling Camp, or employee of Granite Hills High School, the right to consent any medical treatment needed for myself/my son/daughter. I understand the rules and procedures as explained above and I am aware of the risks involved in athletic participation. I hereby state that I or my son/daughter have had and passed a physical examination in the past year and that I am or he/she is in good health in which to compete/participate in rigorous camp activities. I also understand the necessity of using proper techniques while participating in the All American-Save Wrestling Camp. I hereby assume all responsibilities for myself or my son/daughter and in accordance to the Education Code Section 72640, I hereby hold the State of California, Porterville Unified School District, or anyone else associated with these associations, and/or any other sponsor(s) or supporters, harmless for all accident, injury, illness, death, or damages occurring by reason of this event conducted on August 2-3, 2013.

______________________________________ _______________________________________________CAMPER SIGNATURE! ! ! DATE PARENT SIGNATURE (if camper is a minor under the age of 18) DATE

REGISTER ONLINE VIA Paypal AThttp://allamericansavewrestlingcamp.eventbrite.com