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Nick Corey

Mid-Season Day Camp w/OSU Head Coach, Tom Ryan

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Premier Technique Wrestling Day Camps, Featuring Ohio State Head Coach, Tom Ryan

Come spend a day with and learn from NCAA D-I Coach of the Year (2009), OSU Head Coach Tom Ryan at Blanchester Intermediate School on January 27, 2013.

10am-3pm. Wrestlers bring a packed lunch.

YOU MAY WALK-UP AND REGISTER ON THE DAY OF THE CAMP, HOWEVER, SECURING YOUR SPOT EARLY ENSURES YOU A SPOT!

Cost is 45.00 per wrestler.

Make checks out to Premier Technique Wrestling. Send payment and registration sheet to:

Bryan Pennix

Blanchester High School

953 Cherry Street

Blanchester, OH 45017

Questions? Contact Nick Corey at nickcorey3@aol.com or 513-484-7575

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Premier Technique Camps With OSU Head Coach Tom Ryan Registration Sheet and Waiver. Print, sign, and send in!

The undersigned, on behalf of ___________________________________ a minor whose birthday is _____________________, and for whom the undersigned is the natural or legal guardian, hereby releases the Premier Technique Wrestling organization, the Blanchester School District, its administrators, coaches, and employees, from any and all liability of whatever nature relating to or in any manner arising out of the use of such minor of the Blanchester wrestling facilities. Furthermore, the undersign agrees to indemnify and hold harmless all previously mentioned parties, from any suit or other legal proceeding, including, but not limited to, attorneys’ fees with respect to the use of the facilities or any part of them by the minor named above. This release and indemnification shall be binding upon the personal representatives, heirs, and assigns of the undersigned and of the minor named above.

I acknowledge that I have read the foregoing paragraph, that I understand it, that I have the option to have it reviewed by legal counsel prior to signing, and that I agree to it.

x_________________________________________________ _ ______________

Printed name of Parent/Guardian Date

x_________________________________________________ _ ______________

Signature of Parent/Guardian Date facilities

Name of Wrestler: _________________________________________ Age: _________

Address: _____________________________________________

Zip Code: ___________

City: _______________________________ State: __________________

Phone Number: _________________________________School/Grade:__________

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Emergency Contact Name & Phone Number

x_________________________________________

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