Place:

Portage Wrestling Clinic

July 21 - 23, 2008

TEAM MIDWEST EXTREME WRESTLING CAMPS

Registration for Portage Clinic

NAME:

E-MAIL ADDRESS:

ADDRESS:

CITY/STATE/ZIP:

TELEPHONE:

GRADE THIS FALL:

As the parent/legal guardian of the above named athlete, I understand and agree that the Portage Public Schools, the Midwest Extreme Wrestling Club and its clinicians, and anyone else connected with the facilities used assume no responsibility for accidents, injuries, medical, or dental expenses incurred by my son/daughter while participating in this program.

Parent or Legal Guardian’s Signature                                                                                       Date

If you have problems opening the document, please download Adobe Acrobat Reader for free at:

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For More Information, Please contact either of the following:

-- Don Nichols at (608) 434-4090 or e-mail dnicjr@charter.net

-- Billy Huebner at (608) 790-2468                                                              

REGISTRATION:

Pre-registration is preferred but not required -- walk-ins are welcome.  If pre-registering, please complete the registration form below and send it with your camp fee to Don Nichols, 824 Parkview Court, Portage, WI  53901.  All pre-registration forms are due by July 20, 2008.  Checks should be made payable to:  EAGLE EXTREME WRESTLING CLUB.

WHO:

time:

cost:

Portage High School

Wrestlers in grades 3-12

$60

6:00 - 8:00 p.m.

Camp fee includes T-shirt.

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