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DeerValleyCommunitySchools

SPRINGWrestlingCamp

Purpose:This3monthpracticescheduleisdesignedtoserveasanintroductiontothesportofwrestlingandadvance
thewrestlingtechniquesofcurrentwrestlers.Thisprogramisopentoallelementary,middleschool,andhighschool
students.This3monthopportunityisdesignedtogivethestudentanoverallunderstandingofthesportofwrestling.
Wewillinstructinallareasofwrestlingandhowitappliestocollegiateandfreestylewrestling.Allwrestlerswillhave
theopportunitytoseehowmovesandskillsareputtogethertocreatethewinningedge.
PRACTICE:

When? EveryTuesdayandThursdayfrom6:307:30p.m.(excludingHolidays/Break)February12April30,2013

Where? DeerValleyHighSchool(51stAve/UnionHills)
WhattoWear? Singlet,tshirt,shorts,wrestlingshoesortennisshoes,personalprotectivegear(headgear,kneepads,
mouthguard)

severndave@gmail.com

Age? Firstgradethroughhighschoolsenior
Contact?DaveSevern,3077603634

Ifenoughstudentssignupthegroupswillbedividedinto2agegroups(1st6thgradeand7th12thgrade).

Fees: $60.00forthethreemonthpackage.ChecksmustbemadeouttoDeerValleyCommunitySchools

Name____________________________________________________________
Age________________
ParentNames________________________________________________________________________________
Address__________________________________________
City______________ ZipCode____________
HomePhone#___________________CellPhone#__________________EmergencyPhone#______________
NameofSchoolCurrentlyAttending______________________________________________________________
PersonAuthorizedtopickupstudent(gradesK8)mustshowphotoID:
____________________________________________________________
__________________________

Name(PLEASEPRINT)

Relationship
Tothebestofmyknowledge,thisstudent/participantdoesnothaveanyhealthproblemsthatwouldbeharmfulto
him/herwhileparticipatinginthiscommunityschoolsprogram.BeitknownthatI,theundersignedparent/guardian/
participantofthenamedstudent/participant,doherebygiveandgrantuntotheinstructormyconsentand
authorizationtorendersuchaide,treatmentorcaretosaidparticipantas,inthejudgmentoftheinstructor,maybe
requiredonanemergencybasis,intheeventsaidparticipantshouldbeinjuredorstrickenill,itisherebyunderstood
thattheconsentandauthorizationherebygivenandgrantedarecontinuous,andareintendedbymetoextendthrough
thelengthoftheprogram.Ifemergencyserviceinvolvingmedicalactionortreatmentisrequiredandneitherthe
parentsnorguardianscanbecontacted,Iherebyconsentfortheparticipanttobegivenmedicalcarebythedoctor
selectedbytheinstructor.(Participantmusthavemedicalinsurancetoparticipate.)

NAMEOFPARTICIPANT:

PARENT/GUARDIAN/PARTICIPANT(ifover18)SIGNATURE:

INSURANCECOVERAGECOMPANY:

POLICYNUMBER:

GROUP#

TheDeerValleyUnifiedSchoolDistrictdoesnotdiscriminateonthebasisofrace,color,nationalorigin,sex,disability,or
ageinitsprogramsoractivities.AnyinquiriesregardingnondiscriminationpolicesmaycontactLegalServices623445
5000.

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