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Also, Nick Walpole, 2011 Graduate University of Indianapolis, and College Wrestlers from Pudue University, W. Lafayette Campus.
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
ADDRESS: __________________________________________________________
SCHOOL___________________________________________________________
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.
Date: ____________________________________________________________.