Owen Wrestling Camp 2010 Application

I will attend:

University of Montana:Technique Camp 6/16-6/19 Team Camp 6/16-6/19 Commuter

Eastern Washington:  Technique Camp 6/25-6/29Team Camp 6/25-6/29 Commuter

T-Shirt size (circle one) Men's S M L XL XXL XXXL

Name _________________________________ Age _______ Weight _________

Address __________________________________________________________

City __________________________________ State _______ Zip ___________

Name of School _____________________________ Grade in School _________

E-mail_________________________________

In case of injury or illness, necessary emergency treatment is authorized.

Insurance Company Policy Number________________________________
I hereby release Owen Wrestling Camp from any and all liability and injuries or illness incurred while in camp. In case of illness or injury incurred while in camp, I authorize the said camp to act for me in any medical emergency, according to their best judgement.

Home Phone _______________________

Parent/Guardian Signature__________________________________

Enclosed is $125 for my deposit. (Check or money order). The balance due ($160) will be paid upon my arrival at camp. Deposits are non-refundable. Make checks payable to Owen Wrestling Camp and mail with application to
Owen Wrestling Camp • P.O. Box 486 • Veradale, WA 99037.