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Resend Confirmation
CAMPER INFORMATION
Wrestler Name
*
Team Name
*
Weight
*
Date of Birth
*
Month
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1900
Experience Level
*
3 or more years
1-2 years
Any information we should know about, including experience/accomplishments
If you plan to attend with a practice partner, please enter his/her name in this space.
Please check appropriate box
WD-30 Camp ($175.00) [Join Waitlist]
July 27-29 at "The Barn"
Coupon Code
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Total
$0.00
PARENT/GUARDIAN INFO
Parent/Guardian Name
*
Email
*
Confirm Email
*
Email #2 (optional)
Street Address
*
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State
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Alaska
Arizona
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California
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District of Columbia
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Idaho
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Louisiana
Maine
Maryland
Massachusetts
Michigan
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Montana
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New Hampshire
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New York
North Carolina
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Ohio
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Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
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Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
AA
AE
AP
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) and The Barn. 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.
Safety and Hygiene Pledge
*
The camper agrees to comply with any policies we implement with regard to COVID-19. The participant (with support and assistance from parents or guardians) also promises to practice good hygiene habits during this camp. 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.
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