Please Print and Send to:
Clay Nagel, 37146 Wosika Drive, Frazee, Mn 56544

NAME_____________________________________________________________

ADDRESS_________________________________________________________

CITY__________________________________STATE_________ZIP___________
 

HIGH SCHOOL______________________________________________________

COACHES NAME____________________________________________________

AGE___________WEIGHT________________GRADE________

Home Phone________________________________________________________

Work Phone/Cell____________________________________________________

Insurance Co._______________________________________________________

Policy#____________________________________________________________

T-Shirt Size  S   M   L    XL   XXL  (circle one)

Roommate Preference_____________________________________

Make checks payable to “Cobber Wrestling Camp”

Enclose a $50 dollar NON-REFUNDABLE deposit.  Send to:  Clay Nagel, 37146 Wosika Drive, Frazee, Mn 56544
Parent/Guardian Authorization:  My son/daughter has had a recent physical examination and is physically able to participate in all camp activities and is free from infectious diseases.  I relieve the directors and Cobber Team Camp of any responsibilities should any accidents occur.  I give my consent for the Cobber trainers and doctors to treat my son/daughter in case of injury or illness.  I understand this wrestling camp is a strenuous and physical activity and serious injury may result in camp participation.  I certify to the best of my knowledge I am in good physical condition and have no disease that would impair my performance in training or competition.

Camper Signature:____________________________________________________

Parent or Guardian Signature: _______________________________________________Date_____________________________

Balance will be due on day of registration
 

This page is maintained by the Concordia Sports Information Office sid@cord.edu
 

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