Twister Wrestling Academy 2015

First Name *

Last Name *

Weight *

School Name *

Email *

USA Wrestling Card # *

Phone number *

Address (Street, City, ST, Zip) *

Parent/Guardian Name *

Parent/Guardian Phone Number *

Upon acceptance of this application, I hereby waive and release any and all rights and claims against Columbus Public Schools and/or Columbus High School and all its employees and agents on account of any injuries or illness sustained by my child while attending camp/tournament. I authorize the director of the camp of his/her designee to select hospital facilities and/or physician of his choice and authorize treatment on an emergency basis in the event such treatment becomes necessary as a result of participation in the Twister Wrestling Academy. *