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					                                                                                                                                                                          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: parogers@purdue.edu
                                                                                                                                                                          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.

				
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