CAMPER INFORMATION

Wrestler Name

Team Name

Weight

Date of Birth

Gender

Male
Female

Experience Level

2 or more years
1-2 years
1 year or less
Never wrestled before

T-Shirt Size

Any information we should know about?

CAMP SELECTION

For our premium camps, a deposit payment can be made. Roughly 50% of the balance can be paid now, and the balance will automatically be charged to your credit card one month before camp begins. You can also pay the entire balance now.

Please check appropriate box

Introduction to Wrestling Summer Camp [August 17-19] ($149.00)
for those who have never wrestled before ; mornings only
Virginia is for Champions Camp [August 11-14] ($299.00)
Virginia is for Champions (Technique Camp Only) ($275.00) [Sold Out]
SOLD OUT!
Virginia is for Champions "College-Style Practice" Only ($149.00) [Sold Out]
SOLD OUT!

Coupon Code

Total

$0.00

PARENT/GUARDIAN INFO

Parent/Guardian Name

Confirm Email

Email #2 (optional)

Street Address

Cell Phone

Cell Phone #2 (optional)

Medical Waiver

I hereby voluntarily permit me or my child to participate in activities at Top of the Podium (TOP). I understand and fully accept there are risks involved in sports, and that accidents and injuries are common and are ordinary occurrences in sports. I hereby agree to accept any and all risks of injury or death, and verify this statement by checking the box below. As consideration for being permitted by TOP to participate in these activities, I hereby release and hold harmless the TOP staff, volunteers and designated coaches from all liability, and from all actions or claims that I or my child now or hereafter have for damage or injury to me or my child, or to any person or property, resulting from the negligence or other acts of any employees or volunteers in connection with me or my child’s participation. I further agree that this waiver, release and assumption of risks is to be binding on the heirs and assigns of the undersigned.

I further agree to indemnify and to TOP (its officers, employees, agents and volunteers) free and harmless from any loss, liability, damage, cost or expense which they may incur as a result of any injury and/or property damage that I or my child may cause or sustain while participating in this activity.

In the event of a medical emergency, I grant permission for TOP volunteers to administer first aid or secure medical treatment for my athlete, provided they are unable to communicate with me, and according to their best judgment. I also hereby give permission to TOP staff and volunteers to disclose the information contained on this form to medical personnel. I agree to pay all medical, hospital, or other expenses which my child or I may incur as a result of such treatment. TOP does not provide any medical or other insurance protection or benefits for those who participate in their programs.

I HAVE CAREFULLY READ THIS RELEASE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN ME AND TOP OF THE PODIUM, INC. ACCORDING TO MY OWN FREE WILL.

I have read and agree to the terms above.

Hygiene Pledge

The participant (with support and assistance from parents or guardians) promises to practice good hygiene habits at TOP. This means trimming nails, wearing clean gear, and informing coaches or TOP staff of any suspicious spots or rashes on the skin before going on the mats.

I have read and agree to the terms above.

Click here for Camp Refund Policy (page 6)

Almost done. Where should we send the confirmation?

Name on Card

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