Summit Summer Camp Registration - Summit Wrestling Club

Name of wrestler *

First

Last

Age *

Name of Parent/Guardian *

First

Last

Parent/Guardian Phone *

Parent/Guardian Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Medical Insurance Company

Medical Insurance Policy Number

Parent/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 *

Summit Camp Age group by grade *

k-5th is 8am-12pm 6th-high school is 8am-4pm

Square

Card

Name on Card