Summer Camp Scholarship Program

Wrestler Name *

First Name

Last Name

Wrestler Date of Birth *

MM

DD

YYYY

Wrestler Gender *

Man

Woman

Transgender

Non-binary/non-conforming

Prefer not to respond

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian Name *

First Name

Last Name

Parent/Guardian Phone *

(###)

###

####

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Is your wrestler (or you) currently covered by medical insurance? *

Yes

No

Would you need transportation to camp? *

Yes

No

Would you be interested in BTS Bay Area hosting a camp or clinic in Oakland? *

Yes

No