World of Wrestling - Roller Productions
Shane Roller's 2008 All-Star Camp Application
- Roller's 2009-10 All-Star Clinic Application -
Thanks for your interest in our wrestling clinics!
* 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 | ||||
| *Age | *Weight | |||
*Please charge a deposit of : $ You must pay the the full amount of $. A balance of $ is Due upon arrival to the Clinic. Please note that your payment 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 Roller All Star Clinic Staff to act for me, according to its best judgement in any medical emergency, and I hereby waive and release said clinic from any liability for injuries or illness incurred by my son/daughter while attending the clinic. |
||||
*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
I would like to thank the Coste and Allen family, along with the people at the Eastern Worlds tournament for their honesty about the 8 and under outstanding wrestler. It takes alot of class to do what these people did for my son, and I want to thank all involved. There was a controversy on my sons fall times, and after much discussion we all came to the correct conclusion. Much thankx from the Ballantine family!
Dalton Ballantine