Anton Talamantes Presents: The Heart and Soul Wrestling Commuter Mini-Camp

Camp Instructors and Technicians:

--------------Mon., June 13th.--------------------------Tue., June 14th.------------------------Wed., June 15th.-----------------------Thu., June 16th.

--------- ---------------- -------------- --------------

-----------------Leroy Vega---------------------------Anton Talamantes----------------Dan ‘The Beast’ Severn---------------------Ed Pendoski

Also, Nick Walpole, 2011 Graduate University of Indianapolis, and College Wrestlers from Pudue University, W. Lafayette Campus.

Eligibility: Males; Age Groups, 5 through 11; and, 12 through 18 years.

When: Monday, through Thursday - June 13 through 16, 2011. - Age Group, 5-11: - 1 to 3 P.M.; - 12-18: - 1 to 4 P.M.

Where: Bishop Dwenger High School; (Air-conditioned) Student Activities Center Gym ;
1300 East Washington Center Road - Fort Wayne, Indiana 46825 - Enter Facility, -VIA.- Door Number ‘5’

---Fees: Ages 12 to 18 yrs. $100.00 per camper ($75 reduced group rate of 5 +) RSVP by May 31st.. After June 1st. $125.00
------------------------------------Ages 5 to 11 yrs. $75.00 per camper ($50 reduced group rate of 5+) RSVP by May 31st. After June 1st. $100.00

Write checks payable to: Anton Talamantes - Mail to: 1914 River Run Trail, Fort Wayne, IN 46825
Contact Information: Email – antonvito1@yahoo.com or telephone: Cell, (253) 861-4001

Dress: Shorts and tee-shirt, Gym Shoes, and or Wrestling Shoes

Commemorative Tee-Shirts: distributed to campers on last day's session.

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - Separate at the broken line - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Check Shirt Size: S_________ M_________ L_________ XL___________ XXL__________

NAME: ___________________________________________________ AGE: _________

ADDRESS: __________________________________________________________

CITY, STATE: _______________________________________________ ZIP: 46___________

PHONE NBR. (______)_____________________________

SCHOOL___________________________________________________________

WAIVER AND PARENT PERMISSION

I do hereby willingly and knowingly assume all rights and hazards incidental to participation including transportation to and from Bishop Dwenger
High School, permitting said wrestling camp participation, to be held. I/We do hereby waive, release, absolve, indemnify and agree to hold harmless
the Fort Wayne-South Bend Catholic Diocese, Bishop Dwenger High School, and any and all employees, servants or agents of said mention
organizations, including but not limited to the organizers, sponsors, supervisors, participants, or Anton Talamantes for any, and all claims or
damages which the participants named above might receive in said camp participation.

I __________________________, will follow the rules or the program, and I understand that if, I am under 18 years of age, confirmation of this
agreement, by my parents/guardians, is required. I/We the undersigned hereby authorize any first aid, medication, medical treatment, or surgery
deemed necessary in case of emergency for _________________________, a participant in this program. I/We authorize the attending personnel to
execute on my/our behalf if I/We are not immediately able to do so.

Camper signature: ____________________________________________________.

Parent signature: ______________________________________________________.

Date: ____________________________________________________________.