Registration

2020 Registration Form

* Indicates required field

Name *

First

Last

Date of Birth ex. 6/25/2011 *

USA Wrestling Number (optional) *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Years of wrestling experience *

1-2 years 3-4 years 4+ years

T-Shirt Size *

The health of the person described above is excellent and has my permission to engage in all prescribed camp activities, except as noted by an examining physician or me.

Health Notes *

In the event I cannot be reached in an EMERGENCY, I hearby give my permission to the physician selected by the Camp Director, Trainer or Camp Coordinator to hospitalize, secure proper treatment for, to order injection, anesthesia, or surgery for my child named above.

Signature of Parent or Legal Guardian *

Date *

Please list any medicine the wrestler may be allergic to, or any camp activity wrestler should not participate in below:

Health Notes *

Physical Exam For the health safety of the participant, it is strongly recommended that wrestlers have a physical examination within the year prior to attending Camp.

Emergency Contact Person:

Name *

First

Last

Phone Number *

Relationship *

Physician:

Name *

First

Last

Phone Number *

MEDICAL INSURANCE (STRONGLY RECOMMENDED FOR ALL WRESTLERS) THE CAMP ASSUMES NO FINANCIAL RESPONSIBILITY FOR MEDICAL OR DENTAL EXPENSES IN ANY WAY RELATED TO THE MVD WRESTLING CAMP. Hospitals and doctors DO require insurance or payment in case of treatment.

Please list your insurance company and policy number below: *

PLEASE INCLUDE A COPY OF YOUR INSURANCE CARD *

Max file size: 20MB

LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT

Camper *

First

Last

I understand that my child (named above) will be participating in vigorous athletic activities, which present potential risks of serious injury. On behalf of my minor child and all those related to my minor child, I hereby agree that we shall assume the risk of any injuries that may result from my child’s participation the MVD Wrestling Camp and program. In consideration of being allowed to participate in any way in the MVD Wrestling Camp, the undersigned: Agrees that prior to participating he/she will inspect the facilities and equipment to be used, and if he/she believes anything to be unsafe, he/she will immediately advise coach or supervisor of such condition(s) and refuse to participate. I acknowledge and fully understand that the participant will be engaging in activities that involve risk of serious injury, including permanent disability and death, and severe social and economic losses which might result not only from their own actions, inaction, or negligence or others, the rules of play, or the condition of the premises or of any equipment used. Further that there may be other risks not known to or is not reasonably foreseen at this time. Assume the foregoing risks and accept personal responsibility for the damages following such injury, permanent disability or death. I release, waive, discharge and covenant not to sue the MVD Wrestling Camp, its affiliated clubs, respective administrators, directors, agents, coaches, and other employees of the organization, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners, and lessors of premises used to conduct the event, all of which are hereinafter referred to as “release” including Alpine Camp and Conference Centers, agents and affiliated companies, from demands, losses or damages on account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the release or otherwise. I have read the above waiver and release, and understand that I have signed it voluntarily.

Signature of Parent or Legal Guardian *

First

Last

Date *

Permission to Use Photograph

I grant to MVD Wrestling Camps, its representatives and employees the right to take photographs of me and my property in connection with the above-identified subject. I authorize MVD Wrestling Camps, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that MVD Wrestling Camps may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. I have read and understand the above:

Signature of Parent or Legal Guardian *

First

Last

Date *

Afternoon Activities

Choose from the list below, two afternoon activities you wish to be assigned to, designate the day you want to participate in each activity.
Activities that are selected are not guaranteed, they will be assigned on a first some first serve basis.
Please note some of the activities have an additional cost. If you select one of those activities, please include the additional cost with your registration. If the activity you selected has no availability you will be refunded the additional cost at camp check in.

Afternoon activities first choice *

Afternoon activities second choice *

If you select water skiing please complete the Ski School waiver below and upload it here *

Max file size: 20MB

Submit

release_waivers_ski_school_2019.pdf
File Size:	511 kb
File Type:	pdf

Download File