Wrestling Technique Camp - On-line Registration Form

* = required field

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NOTE: Campers MUST have proof of health insurance (photocopy of insurance card) provided to Luther College BEFORE check-in in order to participate in our camps.
First Name*
Last Name*
Grade next fall*
School*
High School Graduation Year*
Gender*
Age*
Birth date (MM/DD/YYYY)*
Height*
Weight*
Home address*
City*
State*
Zip code*
Home phone
Parent's cell phone
Camper's cell phone
Parent's e-mail*
Camper's e-mail
Preferred roommate (one name only)
State Placings/Rankings
2016-17 Season Record
Approximate High School GPA (optional)
Possible College Major (optional)
Adult T-shirt size
OR
Youth T-shirt Size
Refund Policy: Written or e-mailed cancellation notice that is received ten or more business days prior to the first day of camp will result in a full refund, less a $50 cancellation fee.
Attending as*
Payment Amount*

Payment Information

Name as it appears on card*
Billing Street Address*
City*
State/Province*
Zip/Postal Code*
Country*
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