Printable 2009 LV Wrestling Camp Application Form

Camp is July 27th-July 31st at the Forks Community Center from 12 noon to 3.

Wrestler's Name: _________________________________Phone # W__________Cell#_____________Home#____________ E-mail Address_______________

Address______________________________________________ City________________  State________ Zip Code_________________

Age:_____ Weight:______T-Shirt Size (circle one) YS   YM   YL   AS   AM   AL   AXL  Team wrested for during season_________________

Club affiliation_______________Years Experience _____

Payment Type  Check ____ Money Order ____ Purchase Order____ Gift Certificate____ Master Card ____  Visa ____ Amex____ Discover____

Credit Card # ________________________________ Expiration Date: __________  Full Name of Card Holder ______________________
I would like to purchase______Extra T-shirt (s), ($15 each)T-Shirt Size (circle one) YS   YM   YL   AS   AM   AL   AXL

I would like to purchase _____Camp Photo(s) (8x10) at $10 Each.

Bring insurance information to camp and present at registration. Insurance is mandatory.
I hereby authorize the camp directors to seek and receive necessary medical attention for my child while in attendance at the Lehigh Valley Wrestling Day Camp. I agree that my child will attend camp at their own risk, and that I will not in any way hold liable the Lehigh Valley Wrestling Day Camp Directors, coaches, or any other person associated with this camp for any injuries or losses.

Wrestler's Signature __________________________________________   Date ___________

Parent's Signature_________________________________________      Date___________

You may print this application and send to:
Lehigh Valley Wrestling Day Camp
C/O Jack Cuvo
2117 Edgewood Avenue
Easton , PA 18045

Please call Jack with any questions at 610-258-8379 or email us at jackcuvo@enter.net