Michigan Camps Presents DAN “THE BEAST‟ SEVERN’S INTENSE AMATEUR COMMUTER CAMP FOR MIDDLE AND HIGH SCHOOL WRESTLERS JULY 8-10 2014, 9am –3pm COST $150 www.Dansevern.com Location: Stonewall Jackson High School, 8820 Rixlew Lane, Manassas, Virginia 20109

Areas of Instruction: Takedowns-Turning and Pinning- Escapes-Reversals –Leg Riding- Freestyle and Greco Roman Techniques- Throws- Live Wrestling, Takedown tournament and more. www.Dansevern.com ______

SPECIAL GUEST CLINICIAN DAN „THE BEAST‟ SEVERN 1984 & 1988 USA Olympic Wrestling Team Alternate 2006 World Champion Over 4000 match victories and under 100 losses Over 100 State, National, and International titles Former Assistant Coach at Arizona and Michigan State University ARIZONA STATE UNIVERSITY HALL OF FAME 2012 AMATEUR WRESTLING HALL OF FAME *World Record Holder of 21Title Belts,*UFC Hall of Fame Inductee *Former WWE Super Star *2 Time NWA Champion * 3 Time UFC Champion ______CAMP DIRECTOR: Tim Tibbs contact info [email protected] HEAD COACH AT STONEWALL JACKSON HIGH SCHOOL Featured in USA WRESTLING MAGAZINE TWICE HIGH SCHOOL ALL AMERICAN 3 Time Virginia State Champion VHSL Record Book for Outstanding Performance Washington Post All Met Team Single A Hall of Fame Manassas Park High School Hall of Fame Bull Run (Patriots) Hall of Fame CAWL Hall of Fame NVWF Hall of Fame Maryland Junior States Hall of Fame Coached 2-Time Team Champion Coached over 100 finalists in middle and high school.

ALL CAMPERS RECEIVE WATER BOTTLES E.E. WINE INC. MANASSAS AND WARRENTON 703-368-6568 HOOTERS OF MANASSAS VA 703-369-6315 INFORMATION:TIM TIBBS CAMP DIRECTOR [email protected] for available spots www.dansevern.com

YOU MUST TRAIN TO BE A CHAMPION! Don’t Miss This Opportunity To Train with A Legend!!! ______

SPECIAL GUEST CLINICIAN DAN „THE BEAST‟ SEVERN 1984 & 1988 USA Olympic Wrestling Team Alternate 2006 World Champion Over 4000 match victories and under 100 losses Over 100 State, National, and International titles Former Assistant Coach at Arizona and Michigan State University ARIZONA STATE UNIVERSITY HALL OF FAME 2012 AMATEUR WRESTLING HALL OF FAME *World Record Holder of 21Title Belts,*UFC Hall of Fame Inductee *Former WWE Super Star *2 Time NWA Heavyweight Champion * 3 Time UFC Champion

______PLEASE RETURN THIS FORM WITH YOUR CHECK. Payable to Michigan Sports Camp Mail to: Tim Tibbs PO BOX 826 Manassas Va 20113 * Deadline JUNE 15, 2014, no refunds payments are final. At the door is excepted must contact [email protected] for approval $175 cash

NAME______AGE______BIRTH DATE ______ADDRESS______CITY______STATE______ZIP_____ PHONE (______) SCHOOL ______COACH’S NAME______Email Address______Insurance Company______Insurance Policy Number ______Waiver of Liability and Agreement to Indemnify In consideration of your accepting my child’s entry into this tournament, I hereby, for myself, my heirs, executors and administrators, waive and release any and all claims for damages I may have against Michigan Sports Camp, Dan Severn ,Stonewall Jackson wrestling team,/ its employees and agents for any property damage or loss suffered by myself or my child, and for any injury suffered by myself or my child during this activity. Further, I agree to indemnify and hold harmless the said department and county, its employees and agents, from any liability it or they may incur for injury to me, or my child while participating in or attending such activity or for the damages or loss of property. The declaration of any portion of this agreement as void or unenforceable shall not terminate any other portion of the agreement and the remaining portions shall remain in full force and effect

Signature of Parent or Guardian ______Date: ______

Signature of Wrestler ______Date: ______