Duke University's 2010 Blue Devil Wrestling Camps


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Duke Near You Camp
BlennerHassett Middle School, WV
June 22nd - 23rd, 2010
Fulltime [Full Amount] w/ $0 refundable deposit
$150

Please make sure to fill out all of the information below:

Camper Name:
Address:
City:    State:    Zip:
Phone:
Email:
School:
Grade (in Fall):
Classification:Weight:    Shirt Size:
I am a Coach: Yes    No
 
Medical Insurance Co:
Policy #:
Emergency Contact:
Phone #:
Current Medications:
Allergies:
 
I hereby certify that the camper listed above is physically fit to participate in an active wrestling camp during the
days he has registered. i know of no physical impairments which would in any manner limit his participation.

I understand that as a condition of admittance as a camper, the undersigned, on behalf of all parents and guardians, and
on behalf of the applicant, hereby release Blue Devil Wrestling Camps, Duke University, and all employees or agents of
the camps from any and all liability from injury and illness, mental and physical.
Parent/Guardian Virtual Signature:   Date:
Additional Comments:
 

Duke Wrestling Office
Box 90555
Durham, NC 27708
Ph: (919) 681-0249
Fax: (919) 681-7866

19 ACC Champions
36 NCAA Qualifiers
ACC Coach of the Year
2x Highest Team GPA NCAA DI
5 Academic All-Americas (2008)
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