World of Wrestling - Roller Productions
Shane Roller's 2010 All-Star Camp Application
Thanks for your interest in our wrestling camps!
* Indicates Required Fields
| *Camper Name | *Address | |||
| *City | *State | |||
| *Zip Code | ||||
| *Parent/Guardian Name | ||||
| (first) | (last) | |||
| *Home Telephone | *Work | |||
| (format) | 111 111-1111 | 111 111-1111 | ||
| *School Attending | ||||
| *Grade Next Year | *Age *Weight | |||
| Health Information | ||||
| *Health Insurance Company | ||||
| *Policy Number(s) | ||||
| *T-shirt Size:XS S M L XL XXL (Adult Sizes - 100% Cotton) | ||||
*Please charge a deposit of : $ You may pay more than the minimum deposit shown or pay the the full amount of $. A balance of $ is Due upon arrival to Camp. Please note that your deposit is NON-REFUNDABLE. |
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PERMISSION FOR MEDICAL TREATMENT, RELEASE OF MEDICAL INFORMATION AND PAYMENT OF MEDICAL EXPENSE: I REQUEST AND GIVE PERMISSION to physicians and medical staff to treat the above-named participant appropriately, including hospitalization, prescribing medication, and performing emergency medical procedures. I AUTHORIZE release of any medical information to the medical centers which may be pertinent to any diagnosis or treatment of the above-named participant. I UNDERSTAND that any charges resulting from this medical treatment will be billed to me at my address or to my medical insurance carrier. Waiver: My son/daughter has been examined by a physician in the last year and is in good health. I hereby authorize the Shane Roller All Star Camp Staff to act for me, according to its best judgement in any medical emergency, and I hereby waive and release said camp from any liability for injuries or illness incurred by my son/daughter while attending camp. |
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*I agree to the terms listed above |
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Upcoming Tournaments
We have several upcoming tournaments for the 2009-2010 season. Please click the "View All" button below for a listing of tournaments and registration information.
Recent Updates
New Locations
Two new locations are open for a World of Wrestling Tournament! If you or your team are interested in helping in your area, contact your local Convention & Visitors Bureau or Sports Commission and have them give Jack Roller a call at 918-366-4411.
Our Sponsors
Testimonials
This is my sons Richard Ortiz. It is his 2nd year wrestling. He is a sopmore at Bishop Alemany this year and he has already placed in the top 8th in several of the top wrestling tournaments in California. He is an amazing athelete and has a God given talent to be an amazing wrestler. He trains as if he were a horse. His work ethic is like something you have never seen before. He is 2 hours early to practice and stays 2 hours after practice. The Coaches expect great things from this kid. Please be looking out for this kid because he is going to be surprising a lot of people
Richard Ortiz