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					                                                                                                                                                                          Important Information
                                                                              Camp Application
                                                                                                                                                                                                                                         Purdue
 Medical Treatment Authorization Form
      Purdue Wrestling Camps                                                  PhotocoPies AccePted
                                                                                                                                                                          TYPICAL SCHEDULE:
                                                                              Name                                                                                        Breakfast 7am             Dinner 5pm




                                                                                                                                                                                                                                        Wrestling
                                                                                           LAST                              FIRST                  MIDDLE INITIAL
PARTICIPANT’S NAME                                                            E-mail :                                                                                    Session One 9-11am        Session Three 7-8:30pm
                                                                              School Attended                                                                             Lunch 12 Noon             Recreation/Movie 9-11pm
CAMP ATTENDING
                                                                              Grade in school this year                               Actual Weight                       Session Two 2-4pm         Lights Out/Bed Check 11pm
Participants are automatically enrolled in Purdue Camp Insurance              Address                                                                                     *Schedules will vary depending on which camp you choose




                                                                                                                                                                                                                                         Camps
Plan. Eligible covered expenses will be paid only if they are in excess
of other valid and collectible insurance.                                     Age               Home Phone (                    )           –                             ELIGIbILITY: All Purdue Wrestling Camps are open
                                                                              T-shirt Size (Circle One):              YS       S       M        L      XL XXL             to any and all wrestling participants grades 1-12.
1. List any medical conditions that camp personnel should
   be aware of (use additional pages if necessary):                           THE CAMP I WISH To ATTEnD:                                                                  EnRoLLMEnT: All camps have a limited enrollment
                                                                                    CoMPETITIon TAKEDoWn CAMP 1 - June 27–July 1                                          to ensure as much individual work as possible. Upon
                                                                                    ($370Res/$195Com) . . . . . . . . . . . . . . . . . . . . . $100.00 deposit*          acceptance to the camp, you will receive a letter
                                                                                    EXTREME TRAInInG CAMP                                                                 with a list of items to bring, a map with directions to
2. List any medication currently taking:
                                                                                    June 27 - July 1 ($370Res/$195Com) . . . . . . . . $100.00 deposit*                   camp, check–in time and location, emergency phone
                                                                                                                                                                          number at Saint Joseph’s College, and other important
                                                                                                                                                                                                                                       Featuring
                                                                                    MIDDLE SCHooL CAMP
                                                                                    July 11–14 ($350Res/$175Com) . . . . . . . . . .$100.00 deposit*                      information.
                                                                                    ELITE MIDDLE SCHooL CAMP
                                                                                    July 5-7 ($275Res/$125Com) . . . . . . . . . . . . . . $100.00 deposit*               TUITIon CoST: Residential tuition cost includes
3. List any allergies:                                                              TEAM CAMP 1 - June 27-July 1                                                          instruction, lodging, meals, T-shirt, insurance coverage,      Competition Takedown
                                                                                    TEAM CAMP 2 - July 10-14                                                              and recreation. Commuter campers are welcome.                  June 27– July 1, 2011
                                                                                    ($330Res/$175Com) . . . . . . . . . . . . . . . . . . . . . $100.00 deposit*          Commuter tuition cost includes instruction, T-shirt, and
                                                                                    RIDE, GRInD, & TURn CAMP                                                              insurance coverage - NO MEALS INCLUDED.                        Extreme Training Camp
In case of emergency please contact:                                                July 10-14 ($350Res/$175Com) . . . . . . . . . . . . $100.00 deposit*                                                                                June 27–July 1, 2011
                                                                              * Remaining balance of camp fees to be paid at check-in or full                             TRAInER: A trainer will be present at all sessions.
Name                                                                          amount can be paid.
                                                                                                                                                                          There is a well–equipped training room available at            Ride, Grind, and Turn Camp
                                                                                                                                                                          all times for minor illness or injury and to dispense          July 10– 14, 2011
Daytime Phone                        Nighttime Phone                          Are you a member of USAW?                       Yes          No
                                                                                                                                                                          medication as needed.                                          Middle School Camp
   Name of Medical Insurance Company                                                                                                                                                                                                     July 11–14, 2011
                                                                              If yes, card number:                                                                        CAnCELLATIon/REfUnD PoLICY: All requests
   Telephone Number                                                           RESIDEnTIAL	                     I will stay in the dorm                                    for refunds must be made in writing or by e-mail. Your         Elite Middle School Wrestling Camp
                                                                              CoMMUTER                         I will commute                                             camp cost, less a $50 non–refundable administrative            July 5–7, 2011
   Insurance Policy Numbers
                                                                                                                                                                          fee, is refunded without question if you cancel at least
                                                                              Roommate Preference                                                                                                                                        Team Camp 1
                                     , As a parent or legal guardian of the                                                                                               one week prior to the registration date. At any time after
                                                                                                                                                                                                                                         June 27–July 1, 2011
participant named above, I do hereby authorize the director of the            I understand that Saint Joseph’s College, the Camp Director, and all other personnel
                                                                              associated with Purdue Wrestling Camps assume no responsibility for accidents,
                                                                                                                                                                          that date, refunds (less the $50 non–refundable fee) are
wrestling camp, and his subordinates, to seek any medical and/or              injuries, or medical or dental expenses incurred by my son/ daughter at camp. However,      made for medical reasons only and all such requests            Team Camp 2
                                                                              a maximum amount of $5,000.00 of blanket medical expense insurance and $250,000
surgical treatment which is reasonably thought to be necessary for            dental coverage for each accidental injury will be provided for each participant; $100.00   must have a signed statement from your physician. If           July 10–14, 2011
                                                                              deductible. The cost of the insurance is included in the tuition.
the care of my child. The camp director is authorized to incur medical                                                                                                    a cancellation request is not received by the first day
costs necessary to provide medical treatment for my child, and I shall                                                                                                    of instruction, there will be no refund issued. Campers
be fully responsible for honoring such costs. I also authorize the medical    X                                                                                           who must leave during camp due to an illness or injury,
                                                                                SIGNATURE OF PARENT OR LEGAL GUARDIAN
facility to release all information needed to complete insurance claims.
                                                                              Make your check or money order payable to:                                                  will not receive a refund. Refunds are not given to
I authorize payment directly to the medical facility.                         Purdue Wrestling Camp
                                                                                                                                                                          campers who voluntarily leave camp or who are sent
                                                                              Mail to:     PURDUE WRESTLInG CAMP
                                                                                                                                                                          home for disciplinary reasons.
SIGNATURE
(Parent or Guardian)
                                                    DATE                                   C/o PETE RoGERS
                                                                                           Po boX 2907
                                                                                           WEST LAfAYETTE In 47996                                                        nEW! CREDIT CARDS WILL bE ACCEPTED: Must
                                                                                                                                                                                                                                          Saint Joseph’s College
                                                                              For more information, contact Pete Rogers at (765) 494-9137                                 complete on website www.purduesportcamps.com and                      Rensselaer, Indiana
                                                                              E-mail: parogers@purdue.edu
                                                                                                                                                                          follow wrestling link.                                         www.purduesportcamps.com
Camp Philosophy                                                      Purdue Wrestling Camps June 27–July 14, 2011                                                                                                             Camp Staff
Purdue Wrestling Camps are designed to aid
wrestlers who want to maximize their wrestling potential                                                                                                                                                                                     SCoTT HInKEL
                                                                                                                                                                                                                                             Head Coach, Purdue University
and increase their technical skills. At the camps, you                                                                                                                                                                                       Head Coach, East Chicago Central 1990-1993
will learn the strategies that have worked for champion              Competition Takedown Camp                                                     Middle School Camp                                                                        All-American; Most Falls in Purdue History
wrestlers to achieve their personal best.                            June 27-July 1                                                                July 11–14                                                                                Ohio State Champion
                                                                     Scoring from your feet is essential for success! Dominating your              Exciting Middle School Camp for wrestlers entering sixth, seventh                         Indiana Wrestling Hall of Fame
    Camp wrestlers will receive tips and strategies that             opponent with a variety of takedowns is emphasized at all levels of           and eighth grades. Wrestlers will learn how to train for competition in
have worked for national and state champion wrestlers                wrestling. The Competition Takedown Camps will teach you how                  freestyle and folkstyle. Each camper who attends will be instructed in
through daily matches, weight lifting, drilling, and
                                                                     to become an accomplished takedown wrestler through technique                 all facets of wrestling. An emphasis will also be made on how to get                      ToM ERIKSon
                                                                     sessions, drilling workouts, and competition. Wrestlers will be placed on     away from your opponent, a critical area for the continued success of                     Assistant Coach, Purdue University
conditioning.                                                        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
                                                                     throughout the day, followed by individual matches in the evening. A dual     their new found skills.
    In order for wrestlers to obtain maximum benefits                meet finals and individual tournament finals will highlight the conclusion                                                                                              U.S. National Freestyle Champion, 1997
                                                                     of camp. Last year’s camp reached the maximum limit with wrestlers                 Residential cost: $350.00
from any of our camps it is imperative that strict rules                                                                                                                                                                                     Placed 4th at World Freestyle Championships, 1997
                                                                     from five different states in attendance. Not only will you learn from this        Commuter cost: $175.00
                                                                                                                                                                                                                                             Indiana and Illinois Wrestling Hall of Fame member
and guidelines be followed while at camp. Our camp                   camp, but you will also have fun doing it!
director will cover all camp rules during our first session.              Residential cost: $370.00                                                Elite Middle School Wrestling Camp
Failure to comply with these rules will result in the                     Commuter cost: $195.00                                                   July 5-7                                                                                  PETE RoGERS
                                                                                                                                                   The Elite Middle School camp has been designed for the Middle
parents being called and asked to come pick up their                 Team Camp 1 • Team Camp 2                                                     School wrestler who has had previous advanced training and wants to
                                                                                                                                                                                                                                             Assistant Wrestling Coach, Purdue University
                                                                                                                                                                                                                                             Three-time Wisconsin High School State Champion
camper. The Purdue Camps are intended to improve                     June 27–July 1                    July 10-14                                  fine tune individual skills as well as train at a high level for maximum
                                                                                                                                                   performance. Time will be spent on hard drilling, live wrestling, and                     145-1 HS Record
your wrestling - not for baby-sitting.                               Building team cohesiveness and wrestling skill is vital for a program. The    physical and mental conditioning. Instruction will be incorporated                        Ohio State University Team Captain
                                                                     team camp will offer the best of both worlds. Giving teams both elite         to wrestlers based on individual needs. Tough, focused, aggressive
                                                                                                                                                                                                                                             Two-time NCAA Qualifier, Ohio State
High School Coaches
                                                                     instruction as well as 20 live competition matches through team duals.        wrestling will be reinforced. Maximum of 40 wrestlers only.
                                                                     All areas of wrestling will be covered during intense teaching sessions,
                                                                     giving wrestlers the skills and mental toughness to overcome obstacles             Residential cost: $275.00
Current coaches from across the Midwest will be                      on the way to obtaining goals. Teams will consist of 10 members with               Commuter cost: $125.00                                                               bEn WISSEL
                                                                     the weight classes being 110, 120, 130, 140, 152, 165, 180, 200, 220,                                                                                                   Boiler Elite Club Coach
present at all seven camps serving as coaches,
technicians and counselors.
                                                                     275. Additional members of each team will be put together to make
                                                                     more teams. Schools are permitted to enter more than one team. This
                                                                                                                                                   Ride, Grind, & Turn Camp                                                                  Two time All-American
                                                                     camp is available for wrestlers entering the 8th through 12th grades.         July 10–14                                                                                Indiana State High School Champion
                                                                     Coaches are recommended to accompany their team.                              Mat wrestling is a vital technique for every successful wrestler, but                     Nationally Ranked Freestyle Senior Wrestler
                                                                                                                                                   unfortunately is not an important focus during high school competition.
                                                                          Residential cost: 10-15 wrestlers $330.00 each *
                                                                                                                                                   This camp is designed to teach fundamental and advanced techniques
                                                                                            16 or more wrestlers $295.00 each **                   and strategies for top positions. Special emphasis will highlight
                     Wrestling camp facilities                            Commuter cost: 10-15 wrestlers $175.00 each *                            techniques to improve leg rides, arm bards, cradles, tilts, and roll-
                                                                                            16 or more wrestlers $160.00 each **                   through-half situations. Wrestlers will be able to practice and enhance
                                                                                                                                                                                                                                             bEn SPRUnGER
                     The camps will be held at Saint Joseph’s                                                                                      their new techniques through live wrestling every day.                                    Indiana State High School Champion
                                                                          * 1 Coach fREE with 10-15 wrestlers
                     College in Rensselaer, Indiana. Rensselaer is                                                                                                                                                                           NCAA II All American
                                                                          ** 2 Coaches fREE with 16 or more wrestlers                                   Residential cost: $350.00
                     located just off Interstate 65, approximately
                                                                                                                                                        Commuter cost: $175.00                                                               Athletes in Action
                     90 minutes southeast of Chicago and 90
                     minutes northwest of Indianapolis.              Extreme Training Camp                                                                                                                                                   Boiler Elite Head Coach
                     Saint Joseph’s College is an excellent          June 27–July 1                                                                   Campers are expected to come into camp
                     location for these wrestling camps. The         The Extreme Wrestling Camp is designed to provide serious athletes                     in good physical condition
                     cafeteria, residence halls, and wrestling       with the latest techniques and training methods taught by an elite level
                     facility are all located within a two-block     college coaching staff. Wrestlers will be exposed to college style training                                                                              JAKE PATACSIL                  ED PEnDoSKI

                                                                                                                                                   Meals
                                                                     that optimizes their conditioning and intensity. This camp is designed                                                                                   Florida High School            Head Coach
                     area.                                           for dedicated high school age wrestlers who are willing to go the extra
                                                                     mile to become champions. There will be a focus on hard drilling and
                                                                                                                                                                                                                                State Champion               Central Indiana Academy
                     Air conditioned housing                                                                                                                                                                                  NCAA All American
                                                                     cross training that works wrestling conditioning specifically. At the                                                                                                                   Indianapolis, Indiana
                     Camp wrestlers will stay in residence halls     conclusion of the camp there will be a unique obstacle course that will       Commuter meals must be purchased at time of check-                         Big Ten Medal of Honor
                     with air conditioning.                          test the wrestlers limits.
                                                                                                                                                   in for entire camp.
Cafeteria                                                                 Residential cost: $370


                                                                                                                                                                                                                              Counselors
                                                                          Commuter cost: $195                                                                      breakfast cost: $4.50
Wrestlers will be able to enjoy their meals in style with generous
                                                                                                                                                                   Lunch cost: $6.50
lighting and seating. Our offerings will include basic traditional
dining, along with our crisp, fresh salad greens and assorted                                                                                                      Dinner cost: $9.50
                                                                                                                                                                                                                                  CURREnT PURDUE WRESTLERS WILL
toppings at our salad bar, to the cool temptations of soft serve
ice cream, plus many other surprises along the way.                                                 www.purduesportcamps.com                                                                                                      SERvE AS CoUnSELoRS.

				
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