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. |
||||
|
Payment Via 
|
||||
|
|
||||
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. |
||||
*I agree to the terms listed above |
||||
| |
||||
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
The tournaments the Roller group put on are nothing short of amazing. Awards are first class, the schedules are almost to the minute, the opening ceremonies are nothing short of inspiring. I look forward to attending their events with my sons for many more years. Thanks for allowing kids from small clubs to wrestle the kids from all over the country in a fair and unbias format.
Doug Hoselton