Please enable JavaScript in your browser to complete this form.Name of wrestler *FirstLastAge *Name of Parent/Guardian *FirstLastParent/Guardian Phone *Parent/Guardian Email *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeMedical Insurance CompanyMedical Insurance Policy NumberParent/Guardian Signature * Clear Signature I hereby waive and release Summit Wrestling Camp from any and all liability and injuries or illness incurred while in camp. I authorize the said camp to act for me in any medical emergency, according to their best judgement. I understand that no refunds will be issued after the first day of camp. T-shirt Size *Adult SmallAdult MediumAdult LargeYouth SmallYouth MediumYouth LargeSummit Camp Age group by grade *K-5th - $100.006th-12th - $175.00Scholarship - $0.00k-5th is 8am-12pm 6th-high school is 8am-4pmSquareCardName on CardSubmit