Home of the Cobra All-Stars - (Happy Valley, OR)

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CAMP REGISTRATION (click here)

* CAMP TOPIC ATTENDING:

* Traveling with the Cobra Travel Team; yes or no:

* DATE ATTENDING:

* CAMP LOCATION:

* WRESTLER'S FIRST NAME:

* WRESTLER'S LAST NAME:

* AGE:

* WEIGHT:

* WRESTER'S CLUB/SCHOOL TEAM:

USA Wrestling Card No #:

* PARENT OR GUARDIAN NAME:

* Phone Number: for example 503-123-4567:

* EMAIL ADDRESS:

* Street Address:

* City:

* State:

* Zip Code:

Medical Insurance:

Group/Policy #:

Electronic signature, I am the legal guardian to the participant and by checking the box I agree to Cobra Wrestling Systems Registration and Waiver. *

VISA CARD NUMBER (or call 503-956-7022):

VISA 3-digit PIN NUMBER (or call 503-956-7022):

VISA CARD HOLDERS NAME (as it appears on the card):

VISA EXPIRATION DATE:

VISA CARDHOLDERS ZIP CODE:

VISA AMOUNT CHARGED $:

PLEASE CALL WITH ANY QUESTIONS.
COACH SPRAGUE
503-956-7022

* indicates required fields