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Coaching Staff
BRIAN DOLPH - Asst. Coach at Univ of Penn. Brian wrestled for Indiana Univ where he was a 3x All-American
and a NCAA Champion.
SEPA Wrestling
Technique Camp
July 14-17, 2015
MATT VALENTI - Asst. Coach at Univ. of Penn. Matt wrestled for Univ of Penn where he was a 3x All-American
and a 2x NCAA Champion.
Wrestler’s Name _________________________________
STEVE HARNER - Head Coach Conestoga HS. PA Hall of
Fame Coach, and wrestled at Clarion Univ.
Address________________________________________
TOMMY ROHN –Asst. Coach at Bethlehem Catholic HS.
Tommy was an All– American for Lehigh Univ.
State ______________________ Zip ________________
ADAM DERENGOWSKI - He was an assistant coach at Iowa
State and Cornell. Placed 3rd at NCAA for Rider Univ.
Won University National Championship in 1990 and was
a member of U.S. National team in 1994.
School _________________________________________
JIM SAVAGE - Head Coach of Father Judge High School
Plus many more Clinicians and college wrestlers
**Clinicians are subject to change**
SEPAwrestling.com
City ___________________________________________
Email __________________________________________
2013 NCAA Qualifier for Drexel Univ.
Visit us at
Parent or Guardian_______________________________
DEXTER LEDERER - Dexter wrestled for Univ. of Maryland
and was a 2x PA State medalist as well as being
Neshaminy HS’s All-Time winningest wrestler.
FRANK CIMATO - Asst. Coach at Drexel Univ. Frank was a
Maple Point MS
2250 Langhorne-Yardley Rd.
Langhorne, PA 19047
SEPA Wrestling
Technique camp
July 14-17 2015
Phone Number __________________________________
Grade Entering in Fall 2014_________________________
Age _______ DOB _________________ Weight ________
T-shirt size (Choose 1) YS YM YL AS AM AL AXL AXXL
I, the undersigned, individually and as a parent/guardian
of ____________________________(wrestler) a minor,
Ask that he/she be admitted to participate in SEPA wrestling camp. I do hereby agree to release, discharge, and
hold harmless Neshaminy School District, SEPA Wrestling, their owners, agents and employees of and from
all causes, liabilities, damages, claims or demands whatsoever on account of any injury or accident involving the
said minor arising out of the minor’s attendance at the
wrestling camp or in the course of competition and/or
activities held in connection with the wrestling camp. I
also give my permission for my child’s photograph to be
used in promotional material for future camps.
Parent/guardian signature ________________________
Date __________________
Digitally signed by Pennsylvania Youth Wrestling
DN: cn=Pennsylvania Youth Wrestling, o=Pennsylvani Youth
Wrestling, ou=PYW, [email protected], c=US
Date: 2015.05.01 19:49:19 -04'00'
REGISTRATION AND CHECK IN
Registration is to be mailed in to attached
address. Space is limited to the first 80
wrestlers. Once we receive your registration
we will send an email confirmation, along
with your medical history form.
Check-in will be every morning 8:00-8:30
am. All wrestlers must check in every day.
MEDICAL HISTORY FORM
Routine health care will be provided by
our certified athletic trainer. Medical
emergencies and illnesses will be referred to the local hospital. A medical
history form will be emailed upon receiving your registration form.
ANY camper failing to submit this form
will be unable to participate in the
camp.
CAMP SCHEDULE
SEPA camp is designed to build and improve
your wrestling technique by learning from 12
different clinicians what it takes to compete
at the next level. Wrestlers will have 3 technique session a day by 3 different clinicians.
There will matches every day. There will be
conditioning sessions along with lectures.
There will also be some time to cool off in
the pool.
Check-in is at daily at 8:00am
Camp ends daily at 4:30pm
CAMP CHECKLIST
__ Medical Release Form
__ Wrestling shoes
__ Head Gear
__ A few T-shirts and change of clothes
__ Towel, Shampoo, Soap, Showers provided
__ Lock, Lockers will be available
__ Sneakers, There will be outside training
__ Lunch, Bring a lunch or lunch can be
purchased daily
PAYMENT and CANCELLATION POLICY
CAMP CONTACTS
Please make checks payable to SEPA
Wrestling
Kurt Paroly 215-595-4526
Joe Erb
267-907-4807
And mailed to: SEPA Wrestling Camp
Email— [email protected]
PO Box 7038
Penndel, PA 19047
There will be a $75 processing fee for
any cancellation after July 1, 2015
SEPA Wrestling
Technique camp
July 14-17, 2014
Wrestler cost: $200
Coaches cost:
$30 per day, or $100 for all 4 days
Please make checks payable to: SEPA Wrestling
Mail to : SEPA Wrestling Camp
PO Box 7038
Penndel, PA 19047
Included in camp are:
* SEPA Camp T-shirt
* Entry to SEPA Summer Tournament on
Saturday, July 19th at Maple Point MS.
(Entry Form needs to be filled out at camp)
For information on SEPA Wrestling Clubs or on
Visit our website at
SEPAwrestling.com
SEPA Wrestling Tournaments, please Visit us at:
SEPAwrestling.com
Digitally signed by Pennsylvania Youth Wrestling
DN: cn=Pennsylvania Youth Wrestling,
o=Pennsylvani Youth Wrestling, ou=PYW,
[email protected], c=US
Date: 2015.05.01 19:52:42 -04'00'