Medial release
Camp shirt size: Youth ( S, M, L ) Adult (S, M, L, XL, XXL) please circle one
Cliff Keen Singlet size (if applicable)_________________________________________
Wrestler’s Name_________________________Address___________________________________
City_________________State________Zip_________E-mail_______________________________
Weight__________Age__________Grade____________H.S. Graduation Year__________________
School Team________________________Wrestling Experience (years)_______________________
Parent/Guardian Name (PLEASE PRINT)________________________________________________
Telephone Number-Home (____)______________________Work(____)_______________________
I agree to allow my child to be treated by a licensed or registered nurse while attending the NXT LVL WRESTLING CAMP, if necessary and to assume all cost related to such treatment. However, a nurse may not be present while attented the camp.I understand that there is no refund if we (child/parent) should cancel the application. I hereby waive my right to any and all charge backs against The NXT LVL Wrestling Camp or Mike Krause as outlined in the agreement and furthermore agree to resolve any and all disputes that may arise over all matters directly with The NXT LVL Wrestling Camp. I understand that the camper attending the NXT LVL Wrestling Camp using any camp facilities does so at his own risk. The NXT LVL Wrestling Camps, staff, owner, employees and agents, from any and all claims, demands, damages, rights of action or causes of action, present or future, whether the saying be known, anticipated or unanticipated, resulting from of arising out of the campers participation in the camp session or in the use if the facilities.
Parent/Guardian Signature_____________________________Date__________________
Applicant’s Signature_________________________________Date__________________
