Bombers_Wrestling_Camp Flyer 2016 - July 11th 2016 (004)

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! ! !BOMBERS SUMMER WRESTLING CAMP (Registration Form) WRESTLERS NAME:______________________________________________________________________________ ADDRESS:______________________________________________________________________________________ EMAIL:__________________________________________ Phone__________________________________________ ! PARENTS NAME:_________________________________ EMERGENCYCONTACT:___________________________ WRESTLERS AGE: (AS OF JUNE 1 ST ) ________ WEIGHT:_________ MEDICCONDITIONS:__________________________________________________________________________ ALLERGIES:____________________________________ MEDICATION:_____________________________________ T- Shirt Size !Youth !S ____ M____ L ____!Adult !S____ M____ L____ XL____ XXL ____ CAMP DIRECTOR Rich Vitale, Bomber of Frisco Wrestling Club Phone: 201-314-0886 Email; rjvitaleiv@gmail.com Please visit the Bombers website at www.friscobomberswrestling.com For Questions email bombers@friscobomberswrestling.com. Make Checks Payable To: !Bombers of Frisco, LLC. ! Mail To: !3777 Bloomfield Lane !Frisco, Texas 75033 Credit Card Authorization Release Form Credit Card Information (Circle One) !Visa !Mastercard !American Express Credit Card Account #: _______________________ Exp. Date:_______ CCV#: __________
Billing Information Name:_____________________________________________________________________________ Cardholders Billing Address:_______________________________________________________ City:__________________________ State___________ Zip ________________________________ Phone Number:_____________________ Email:________________________________________ I _______________________________________________ (name of card owner) authorize The Bombers of Frisco Wrestling Club (Rich Vitale) to charge the above credit card for Camp Registration. Cancellation/Refund Policy: ALL refund requests need to be submitted in writing and will be refunded without question if you cancel by July 5 th , 2016. At any time after that date, refunds (less a $100 non-refundable fee) are made for medical reasons only and a signed statement from your physician must accompany the written request. If a cancellation request is not received by the last day of instruction, a refund is not issued. Campers who must leave during camp due to an illness or injury verified by our medical personnel will receive a pro-rated refund (written request is necessary). Refunds are not given to campers who voluntarily leave camp or who are sent home for disciplinary reasons. Refunds, for any reason, are not issued after a 30 day period from camp start date. Wrestlers must have valid USA Card PARENT/GUARDIAN RELEASE I the undersigned, hereby certify that I am the parent or legal guardian of the wrestler. I hereby give permission for the staff of The Bombers of Frisco Wrestling Club, LLC. to seek, during the season, camps, appropriate medical attention for the wrestler and for the wrestler to receive medical attention in the event of accident, injury or illness. I will be responsible for any and all medical costs for treatment and or attention. I the undersigned for ourselves, our heirs, executors and administrators, waive, release and forever discharge The Bombers of Frisco Wrestling, Frisco Independent School District, the camp and its staff, officers, agents, employees, representatives, successors, and assign of and from all rights and claims for damages, injury or loss to person or property which may be sustained during participating in camp activities or while at camp, whether or not damages, injury or loss is due to negligence. _______________________________________________________________________________________________ Parents/Guardians Signature (I agree to the terms and conditions of this agreement FRISCO BOMBERS CAMP COACHES Nate Carr 1988 Olympic Medalist 6x National Champion (3x NCAA and 3x National Freestyle) 3x World Team Member Goodwill Games Champion World Cup Champion Pan American Games Champion West Virginia University Asst. Coach 13 Years WVU finished as high as 6th in NCAA 2003 Distinguished Member of the National Wrestling Hall of Fame Joe Carr Sr 3x NCAA All American University of Kentucky Silver Medalist Pan American Games 2x USA Wrestling National Champion World Team Member Woodford County HS Head Coach 30 Years Won 14 State Championships Coached 56 Individual State Champions 2006 Coached 5 Individual State Champion Joe Carr Jr
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Bombers_Wrestling_Camp Flyer 2016 - July 11th 2016 (004)

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