Important Information Medical Treatment Authorization Form Camp Application Purdue Wrestling Camps PhotocoPies AccePted TYPICAL SCHEDULE: Name Breakfast 7am Dinner 5pm PARTICIPANT’S NAME LAST FIRST MIDDLE INITIAL Session One 9-11am Session Three 7-8:30pm *E-mail: Confirmation will come via e-mail Lunch 12 Noon Recreation/Movie 9-11pm CAMP ATTENDING School Attended Session Two 2-4pm Lights Out/Bed Check 11pm Grade in school this year Actual Weight *Schedules will vary depending on which camp you choose Participants are automatically enrolled in Purdue Camp Insurance Address Plan. Eligible covered expenses will be paid only if they are in excess ELIgIbILITY: All Purdue Wrestling Camps are open to any of other valid and collectible insurance. and all wrestling participants grades 1-12. Age Home Phone ( ) – 1. List any medical conditions that camp personnel should T-shirt Size (Circle One): YS Ym S m L XL XXL EnRoLLmEnT: All camps have a limited enrollment be aware of (use additional pages if necessary): THE CAmP I wISH To ATTEnD: to ensure as much individual work as possible. Upon acceptance to the camp, you will receive a letter with a list of ComPETITIon TAKEDown CAmP - June 24–28 items to bring, a map with directions to camp, check–in time ($380Res/$205Com) . . . . . . . . . . . . . . . . . . . . . $100.00 deposit* and location, emergency phone number at Saint Joseph’s EXTREmE TRAInIng CAmP 2. List any medication currently taking: College, and other important information. June 24–28 ($380Res/$205Com) . . . . . . . . . . . . $100.00 deposit* mIDDLE SCHooL CAmP TUITIon CoST: Residential tuition cost includes July 10–13 ($360Res/$185Com) . . . . . . . . . .$100.00 deposit* instruction, lodging, meals, T-shirt, insurance coverage, and Purdue ELITE mIDDLE SCHooL CAmP recreation. Commuter campers are welcome. Commuter 3. List any allergies: June 28-30 ($275Res/$125Com) . . . . . . . . . . . . $100.00 deposit* tuition cost includes instruction, T-shirt, and insurance TEAm CAmP 1 - June 24–28 coverage - NO MEALS INCLUDED. TEAm CAmP 2 - July 9–13 ($340Res/$185Com) . . . . . . . . . . . . . . . . . . . . . $100.00 deposit* TRAInER: A trainer will be present at all sessions. There is RIDE, gRInD, & TURn CAmP a well–equipped training room available at all times for minor In case of emergency please contact: “Boiler Tough” July 9-13 ($360Res/$185Com) . . . . . . . . . . . . . $100.00 deposit* illness or injury and to dispense medication as needed. Name * Remaining balance of camp fees to be paid at check-in or full amount can be paid. mEALS: Commuter meals must be purchased at time of Daytime Phone Nighttime Phone check-in for entire camp. Wrestling How did you find out about Camp? Breakfast cost: $4.50 Name of Medical Insurance Company Lunch cost: $6.50 Dinner cost: $9.50 Telephone Number RESIDEnTIAL I will stay in the dorm CAnCELLATIon/REfUnD PoLICY: All requests for Insurance Policy Numbers Camps refunds must be made in writing or by e-mail. Your camp cost, CommUTER I will commute (meals not included) , As a parent or legal guardian of the less a $50 non–refundable administrative fee, is refunded participant named above, I do hereby authorize the director of the Roommate Preference without question if you cancel at least one week prior to the wrestling camp, and his subordinates, to seek any medical and/or I understand that Saint Joseph’s College, the Camp Director, and all other personnel associated with Purdue Wrestling Camps assume no responsibility for accidents, registration date. At any time after that date, refunds (less surgical treatment which is reasonably thought to be necessary for injuries, or medical or dental expenses incurred by my son / daughter at camp. However, the $50 non–refundable fee) are made for medical reasons a maximum amount of $5,000.00 of blanket medical expense insurance and $250,000 the care of my child. The camp director is authorized to incur medical dental coverage for each accidental injury will be provided for each participant; $100.00 only and all such requests must have a signed statement deductible. The cost of the insurance is included in the tuition. from your physician. If a cancellation request is not received June 24–July 13, 2012 costs necessary to provide medical treatment for my child, and I shall be fully responsible for honoring such costs. I also authorize the medical X by the first day of instruction, there will be no refund issued. facility to release all information needed to complete insurance claims. SIGNATURE OF PARENT OR LEGAL GUARDIAN Campers who must leave during camp due to an illness or make your check or money order payable to: I authorize payment directly to the medical facility. Purdue wrestling Camp injury, will not receive a refund. Refunds are not given to campers who voluntarily leave camp or who are sent home Mail to: PURDUE wRESTLIng CAmP C/o PETE RogERS for disciplinary reasons. Held at SIGNATURE (Parent or Guardian) DATE Po boX 2907 wEST LAfAYETTE In 47996 CREDIT CARDS wILL bE ACCEPTED: Must complete on Saint Joseph’s College For more information, contact Pete Rogers at (765) 494-9137 website www.purduesportcamps.com and follow wrestling Rensselaer, Indiana E-mail: firstname.lastname@example.org link. www.purduesportcamps.com Camp Philosophy Each student-athlete will leave the Purdue Purdue Wrestling Camps June 24–July 13, 2012 Camp Staff “Boilermaker Tough” Wrestling Camps with a SCoTT HInKEL thorough knowledge of the four areas of athletic Head Coach, Purdue University development—technical, physical, mental and Head Coach, East Chicago Central nutritional. Competition Takedown Camp middle School Camp All-American; Most Falls in Purdue History June 24–28 July 10–13 Ohio State Champion The camps will focus on developing the technical Scoring from your feet is essential for success! Dominating your Indiana Wrestling Hall of Fame Exciting Middle School Camp for wrestlers entering sixth, seventh component. But the staff will also lecture on the opponent with a variety of takedowns is emphasized at all levels of and eighth grades. Wrestlers will learn how to train for competition in mental and nutritional preparation needed to excel wrestling. The Competition Takedown Camps will teach you how to become an accomplished takedown wrestler through technique freestyle and folkstyle. Each camper who attends will be instructed in Tom ERIKSon in wrestling. Campers will also learn about various sessions, drilling workouts, and competition. Wrestlers will be placed on all facets of wrestling. An emphasis will also be made on how to get Assistant Coach, Purdue University away from your opponent, a critical area for the continued success of workouts the Purdue Wrestling Team implement in teams and assigned coaches for the week. Dual meets will take place your wrestling. Competition will be included for all campers to try out Two-time NCAA All American daily training. throughout the day, followed by individual matches in the evening. A dual U.S. National Freestyle Champion their new found skills. meet finals and individual tournament finals will highlight the conclusion Placed 4th at World Freestyle Championships As clinicians, we are aware of the importance of of camp. Last year’s camp reached the maximum limit with wrestlers Residential cost: $360 Illinois Wrestling Hall of Fame from five different states in attendance. Not only will you learn from this one-on-one instruction. Our staff is willing to help camp, but you will also have fun doing it! Commuter cost: $185 any athlete after sessions to ensure that each and Residential cost: $380 PETE RogERS every wrestler gets the most out of our camp. Commuter cost: $205 Elite middle School wrestling Camp Assistant Wrestling Coach, Purdue University Our philosophy centers around high percentage June 28–30 Head Wrestling Coach, Lakeland College techniques that have worked for national and state Team Camp 1 • Team Camp 2 The Elite Middle School camp has been designed for the Middle Three-time Wisconsin H.S. State Champion champion wrestlers. We at the Purdue “Boilermaker June 24–28 July 9–13 145-1 H.S. Record School wrestler who has had previous advanced training and wants to Ohio State University Team Captain Tough” Wrestling Camps believe that becoming a Building team cohesiveness and wrestling skill is vital for a program. fine tune individual skills as well as train at a high level for maximum The team camp will offer the best of both worlds. Giving teams both performance. Time will be spent on hard drilling, live wrestling, and Two-time NCAA Qualifier, Ohio State well rounded wrestler in all positions - neutral, top, elite instruction as well as live competition matches through team duals physical and mental conditioning. Instruction will be incorporated and bottom can make you a champion wrestler. and tournaments. All areas of wrestling will be covered during intense to wrestlers based on individual needs. Tough, focused, aggressive bEn wISSEL We believe our camps not only cover those areas teaching sessions, giving wrestlers the skills and mental toughness to wrestling will be reinforced. Maximum of 40 wrestlers only. Boiler Elite Club Coach overcome obstacles on the way to obtaining goals. Teams will consist Two-time All-American but teach you how to excel in them. of 10 members with the weight classes being 110, 120, 130, 140, 152, Residential cost: $275 165, 180, 200, 220, 275. Additional members of each team will be put Indiana State High School Champion The Purdue “Boilermaker Tough” Wrestling Camp’s together to make more teams. Schools are permitted to enter more than Commuter cost: $125 Nationally Ranked Freestyle Senior Wrestler staff believes people are measured not only by one team. This camp is available for wrestlers entering the 8th through what they do, but by the way they do it. During 12th grades. Coaches are recommended to accompany their team. Ride, grind, & Turn Camp the camp, each student-athlete will be taught that Residential cost: 10-15 wrestlers $340 each * July 9–13 bEn SPRUngER performing like a champion on the mat requires 16 or more wrestlers $305 each ** Indiana State High School Champion A fall is the ultimate expression of domination in wrestling. This camp acting like a champion off the mat. Commuter cost: 10-15 wrestlers $185 each * focuses on techniques that put your opponent in a pinning situation. NCAA II All American 16 or more wrestlers $170 each ** This camp is designed to teach fundamental and advanced techniques Athletes in Action Do you have what it takes to be? * 1 Coach fREE with 10-15 wrestlers and strategies for top positions. Special emphasis will highlight Boiler Elite Head Coach techniques to improve leg rides, arm bards, cradles, tilts, throws, ** 2 Coaches fREE with 16 or more wrestlers and roll-through-half situations. Wrestlers will be able to practice and Boilermaker tough! enhance their new techniques through live wrestling every day. Extreme wrestling Camp June 24–28 Residential cost: $360 JAKE PATACSIL ED PEnDoSKI Commuter cost: $185 Florida High School Head Coach The Extreme Wrestling Camp is designed to provide serious athletes with the latest techniques and training methods taught by an elite State Champion Central Indiana Academy level college coaching staff. Wrestlers will be exposed to college style NCAA All American Indianapolis, Indiana training that optimizes their conditioning and intensity. They will learn Big Ten Medal of Honor Campers will to physically and mentally beat their opponents. There will be a focus Campers are expected to come into High School Coaches enjoy working with on hard drilling and cross training that works wrestling conditioning specifically. At the conclusion of the camp there will be a unique Purdue University obstacle course that will test the wrestlers limits. Wrestlers who attend camp in good physical condition Current coaches from across the Midwest will be Head Coach, this camp are expected to arrive in good physical condition. Scott Hinkel, and present at all seven camps serving as coaches, Residential cost: $380 technicians and counselors. current Purdue Commuter cost: $205 wrestlers and Counselors coaches. www.purduesportcamps.com Current Purdue wrestlers will serve as counselors.