Photo Credit: Jordyn Hulinsky, The Eagle

Please Detach And Return

2016 CSC WRESTLING CAMPRegistration FormName ___________________________________

Home Phone _______________________________

Address _________________________________

City ____________________________________

State ________ Zip ________________________

High School _______________________________

Grade Entering 2016 ______ Wt. Class ______________

# Varsity years __________Camp Wt. Class __________

Birth Date ____ /____/ ____ Shirt Size S M L XL XXL

Father’s Name ______________________________

Work Phone _______________________________

Mother’s Name _____________________________

Work Phone _______________________________

Emergency Contact ___________________________

Phone ___________________________________Please check all that apply: ____ Non Refundable $50.00 Deposit

____ Full Pymt

____ Commuter ____ Resident

____________ Total Enclosed

Make checks payable to: Eagle Wrestling Camp

Please fill out both sides of this form and mail to:Brett HunterWrestling Camp Director1000 Main StreetChadron, NE 69337

Chadron State College is an equal opportunity institution. CSC does not discriminate against any student, employee or applicant on the basis of race, color, national origin, sex, sexual orientation, gender identity, disability, religion, or age in employment and education opportunities, including but not limited to admission decisions. The College has designated an individual to coordinate the College’s nondiscrimination efforts to comply with regulations implementing Title VI, VII, IX, and Section 504. Inquiries regarding non-discrimination policies and practices may be directed to Interim Title VI, VII, IX Compliance Coordinator, Sherri Simons, Chadron State College, 1000 Main St., Chadron, NE 69337, 308-432-6479; email: titleixcoordinator@csc.edu.

Photo Credit: Jordyn Hulinsky, The Eagle

Please Detach And Return

2016 CSC WRESTLING CAMPRegistration FormName ___________________________________

Home Phone _______________________________

Address _________________________________

City ____________________________________

State ________ Zip ________________________

High School _______________________________

Grade Entering 2016 ______ Wt. Class ______________

# Varsity years __________Camp Wt. Class __________

Birth Date ____ /____/ ____ Shirt Size S M L XL XXL

Father’s Name ______________________________

Work Phone _______________________________

Mother’s Name _____________________________

Work Phone _______________________________

Emergency Contact ___________________________

Phone ___________________________________Please check all that apply: ____ Non Refundable $50.00 Deposit

____ Full Pymt

____ Commuter ____ Resident

____________ Total Enclosed

Make checks payable to: Eagle Wrestling Camp

Please fill out both sides of this form and mail to:Brett HunterWrestling Camp Director1000 Main StreetChadron, NE 69337

Chadron State College is an equal opportunity institution. CSC does not discriminate against any student, employee or applicant on the basis of race, color, national origin, sex, sexual orientation, gender identity, disability, religion, or age in employment and education opportunities, including but not limited to admission decisions. The College has designated an individual to coordinate the College’s nondiscrimination efforts to comply with regulations implementing Title VI, VII, IX, and Section 504. Inquiries regarding non-discrimination policies and practices may be directed to Interim Title VI, VII, IX Compliance Coordinator, Sherri Simons, Chadron State College, 1000 Main St., Chadron, NE 69337, 308-432-6479; email: titleixcoordinator@csc.edu.

2016 CHADRON STATEWRESTLING CAMP JUNE 19-22

IntroductionThe 18th annual Chadron State College Wrestling Team Camp is primed for success. The previous year’s camps were a huge success with over 300 wrestlers from 20 different teams. The team camp concept will feature technique sessions with each team having their own CSC representative for individualized instruction. This year’s camp will focus more on technique, with more time to work with CSC Wrestlers. During the camp, each team will be entered into a dual meet schedule allowing for as many matches as possible

Check-InsSunday, June 19, 2016Noon - 3:45 p.m.Nelson Physical Activity Center (CSC Campus)

Check-OutWednesday, June 22, 201611 a.m.

Age LimitsStudents entering the eighth grade and up to those entering the twelfth grade are eligible to participate.

CostsOne Coach free with minimum 5 campers2 Coaches Free with minimum 10 campers$120.00 per coach over 2$175.00 per resident camper$120.00 per commuter camper*Commuter cost includes lunch tickets

Please submit entriesBy June 1, 2016

More Information CSC Head Coach Brett Hunter: 308-432-6305 bhunter@csc.edu

Sarah Dykes: 308-432-6255 sdykes@csc.edu

What to Bring*A current physical required at the time of check-in.*Plenty of workout equipment, swimsuit. *Personal items such as: towels, toilet items, sheets, pillows, blanket and spending money for free time.

2016 Wrestling Coaching Staff Head Coach: Brett Hunter Assistant Coaches: Kamron Jackson, Phil Bullington, Dustin Stodola, Dylan Fors Special Guest Coach: Brandon Slay Assistant National Freestyle Coach and National Freestyle Resident Coach for USA Wrestling; 2000 Olympic Gold Medalist

Top Teams From Last Year’s Camp Nebraska WyomingNorth Platte - Class A - 13th Powell - 4-time Class 3A Scottsbluff - Class A Runner-Up Defending State ChampionsPlattsmouth - Class A - 3rd Douglas - Class 3A Runner-UpWest Point-Beember -Class B - 5th Cody - Class 3A - 4thChadron - Class B - 11th Lander - Class 3A - 6thAlliance - Class B - 20th Torrington - Class 3A - 7thO’Neill - Class C State Champions ColoradoValentine - Class C Runner-Up Thompson Valley - Class 4ACentennial - Class C - 6th State ChampionsAinsworth - Class C- 22nd Mesa Ridge - Class 4A - 9thNorth Platte St. Pat’s - Class D- 6th Rocky Mountain - Class 5A - 5thScribner-Snyder - Class D - 8th South DakotaCentral Valley - Class D - 16th Spearfish - Class A - 6thFranklin - Class D - 18th Hot Springs - Class B - 11th

CaliforniaElk Grove

General Information*The residence halls will be supervised at all times by the camp staff and the residence hall directors. Each camper should bring his own bedding or sleeping bag. The residence halls are air-conditioned.*The camp fee includes the use of the facilities, wrestling instruction, a camp T-shirt, awards and three meals a day for all resident campers. In addition, there will be the use of the Student Center and the snack bar located in the Student Center.

Please Detach And Return

2016 CSC WRESTLING CAMPAuthorization and Release FormNote: In order for your child to participate in the 2016 Chadron State Wrestling Camps on, this form must be completed, signed and returned to the College prior to the first day of camp.

_______________________________________Child’s Printed Name

_______________________Child’s Date of Birth

Authorization I authorize and give my consent for any licensed medical provider or athletic trainer to provide medical treatment, emergency services or assistance to my child related to his/her participation in Chadron State Wrestling 2016 Camp. I agree to assume all costs related to such treatment, services or assistance.

_______________________________________Insurance Company

_______________________________________Policy Number

Release I give permission for my child (identified above) to participate in the Chadron State Wrestling 2016 Camp. I assume all risks of accident or injury that may result from his/her participation in this activity. I release the Nebraska State Colleges, the Board of Trustees of the Nebraska State College, Chadron State College, and all officers, employees, agents, volunteers, and participants from liability including, but not limited to, legal claims and suits for any injury, damage or loss (personal or property) resulting from his/her participation in this activity.

_______________________________________Parent/Guardian Printed Name

_______________________________________Parent/Guardian Signature

_______________________Date

2016 CHADRON STATE WRESTLING CAMP

PERSONAL INFORMATION SHEET Name___________________________________________ Home Phone (______)___________________________ Cell Phone (______)_________________________

Street________________________________________________________City_______________________________State___________Zip Code __________________

High School_______________________________ Grade Entering in 2016________ Shirt Size S M L XL XXL Birth date _____/_____/_____

# Varsity Years______________________________ Wt. Class __________________________ Camp Wt. Class_____________________________________________

Father’s Name______________________________________________________________________ Phone (______)_________________________________________

Mother’s Name_____________________________________________________________________ Phone (______)_________________________________________

Emergency Contact__________________________________________________________________ Phone (______)_________________________________________

Insurance Company__________________________________________________________________ Phone (______)_________________________________________

Policy Number_________________________________________

(Please Check all that apply)

PAYMENT: ❑ $50 Deposit ❑ Partial $_________ ❑ Full

CAMP: ❑ Per Coach (over 2): $120

❑ Overnight: $175

❑ Commuter: $120

TOTAL ENCLOSED $__________

(Please Make checks payable to Eagle Wrestling Camp)

PLEASE READ AND SIGN THE RELEASE ON THIS FORM AND RETURN IT WITH YOUR PERSONAL INFORMATION SHEET TO:

CSC WRESTLING CAMP

1000 Main St.

Chadron, NE 69337

2016 Eagles Wrestling Camp Authorization and Release Form

Note: In order for your child to participate in the Chadron State 2016 Eagles Wrestling Camp, June 19-22, this form must be completed, signed and returned

to the College prior to the first day of camp.

_____________________________________ Child’s Printed Name

_____________________________________ Child’s Date of Birth

Authorization I authorize and give my consent for any licensed medical provider or athletic trainer to provide medical treatment, emergency services or assistance to my

child related to his/her participation in Chadron State 2016 Eagles Wrestling Camp. I agree to assume all costs related to such treatment, services or

assistance.

_____________________________________ Insurance Company

_____________________________________ Policy Number

Release I give permission for my child (identified above) to participate in the Chadron State 2016 Eagles Wrestling Camp. I assume all risks of accident or injury

that may result from his/her participation in this activity. I release the Nebraska State Colleges, the Board of Trustees of the Nebraska State College,

Chadron State College, and all officers, employees, agents, volunteers, and participants from liability including, but not limited to, legal claims and suits

for any injury, damage or loss (personal or property) resulting from his/her participation in this activity.

_____________________________________ Parent/ Guardian Printed Name

_____________________________________ _____________________________ Parent/Guardian Signature Date

PLEASE READ AND SIGN THE RELEASE ON THIS FORM AND RETURN IT WITH YOUR PERSONAL INFORMATION SHEET TO:

CSC WRESTLING CAMP

1000 Main St.

Chadron, NE 69337

2016 Eagles Wrestling Camp Authorization and Release Form

Note: In order for your child to participate in the Chadron State 2016 Eagles Wrestling Camp, June 19-22, this form must be completed, signed and returned

to the College prior to the first day of camp.

_____________________________________ Child’s Printed Name

_____________________________________ Child’s Date of Birth

Authorization I authorize and give my consent for any licensed medical provider or athletic trainer to provide medical treatment, emergency services or assistance to my

child related to his/her participation in Chadron State 2016 Eagles Wrestling Camp. I agree to assume all costs related to such treatment, services or

assistance.

_____________________________________ Insurance Company

_____________________________________ Policy Number

Release I give permission for my child (identified above) to participate in the Chadron State 2016 Eagles Wrestling Camp. I assume all risks of accident or injury

that may result from his/her participation in this activity. I release the Nebraska State Colleges, the Board of Trustees of the Nebraska State College,

Chadron State College, and all officers, employees, agents, volunteers, and participants from liability including, but not limited to, legal claims and suits

for any injury, damage or loss (personal or property) resulting from his/her participation in this activity.

_____________________________________ Parent/ Guardian Printed Name

_____________________________________ _____________________________ Parent/Guardian Signature Date