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2015 Charlotte Elite Wrestling Club Registration Packet CHARLOTTE ELITE Wrestling

Charlotte Elite Wrestling Club Registration Packet

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Come join us at Elon Park Recreation Center Tuesday's & Thursday's from 4:30 PM-6:00 PM!

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  • 2015

    Charlotte Elite Wrestling Club Registration Packet

    CHARLOTTE ELITE Wrestling

  • Coaching Staff: Brian Thompson (336) 682-3096 [email protected]

    Chris Foy (252) 814-4001 [email protected]

    Elon Park Recreation Center Gym 11401 Ardrey Kell Rd, Charlotte, NC (HS Practice ) T & TR 4:30 PM-6:00PM (Elem-Middle) M & W 5:30 PM-7:00 PM

    Bolded events Charlotte Elite coaches will be in attendance

    Charlotte Elite 2014-2015 Spring/Summer Wrestling Schedule

    Date: Event: Site: Type: Tuesday, April 7 1st Day of Practice (HS Wrestlers) Elon Park Rec Saturday, April 11 RS Central Ironman Clash RS Central High FO/FR/GR Friday-Saturday, April 17-18 Tarheel State Classic Chapel Hill High FR/GR Saturday, April 25 Trojan Clash NW Cabarrus High FR/GR Friday-Saturday, May 1-2 NC State Tournament LJVM Annex FR/GR Monday, May 4 1st Day of Practice (Elem-Middle) Elon Park Rec Saturday, May 9 Throwdown In Motown Mooresville, NC FR/GR Saturday, May 16 West Side Showdown Clash West Forsyth High FO Friday-Sunday, May 22-24 Cliff Keen SE Regionals Atlanta, GA FO/FR/GR Friday-Saturday, May29-30 US Beach Wrestling Nationals Carolina Beach Beach Wednesday-Sunday, June 3-7 Schoolboy National Duals Indianapolis, IN FR/GR Saturday-Sunday, June 6-7 East Coast Duals Pasadena, MD FR/GR Tuesday-Saturday, June 9-13 Cadet National Duals York, PA FR/GR Saturday, June 20 Powerade State Games Raleigh, NC FR/GR Sunday-Wednesday, June 21-24 UNC Pembroke Camp UNC Pembroke FO Tuesday-Saturday, June 23-27 Junior National Duals Tulsa, OK FR/GR Tuesday-Thursday, June 30-July 2 Kids Freestyle & Greco-Ro. Nats Wisconsin Dells, WI FR/GR Saturday-Saturday, July 18-25 Cadet & Junior Nationals Fargo, ND FR/GR

    Charlotte Elite

  • Charlotte Elite Wrestling Club Registration Form

    PAYMENT INFO

    * MONTHLY DUES WILL AUTOMATICALLY BE DRAFTED ON THE 7TH OF EACH MONTH IF CASH OR CHECK HAS NOT BEEN RECEIVED*

    ATHLETE NAME

    PHONE NUMBER

    EMAIL ADDRESS

    CITY

    STATE & ZIP

    DATE OF BIRTH

    WEIGHT

    GRADE

    GAURDIAN NAME

    GUARDIAN PHONE #

    GUARDIAN EMAIL

    I.C.E CONTACT NAME

    I.C.E. PHONE NUMBER

    I.C.E RELATIONSHIP

    CARD TYPE VISA AMEX DISCOVERY MASTERCARD

    CARD NUMBER

    EXPERATION DATE

    CSV CODE

    AUTHORIZATION SIGNATURE

  • Charlotte Elite 1.) Registration Package (select one)

    + 2.) Membership Package: (select one)

    *6 Month Package paid in advance with registration

    Example (New member registering with Essentials Pack)

    Essentials Competitor Elite USAW Membership Limited Liability

    Insurance Team Shirt Team Shorts

    USAW Membership Limited Liability

    Insurance Team Shirt Team Shorts Team Wrestling Bag

    USAW Membership Limited Liability

    Insurance Team Shirt Team Shorts Team Wrestling Bag Team Technique

    Notebook Team Singlet (FS/GR)

    $65 $105 $235

    New members must include registration with first month dues.

    Duration Total Cost (Monthly Breakdown)

    1 Month $120 ($120) 3 Months $300 ($100) 6 Months* $540* ($90)

    1st Month 2nd Month 3rd Month 4th Month

    1 Month $185 $120 $120 $120

    3 Months $165 $100 $100 $100

    6 Months $605 - - -

    *First payment must be cash or check payable to: Charlotte Elite Wrestling

    1.) Registration Pack $65 (Essentials)

    + 2.) Duration Pack $100 (3 Month)

    = Total $165

  • !Charlotte Elite !!!RELEASE AND WAIVER OF LIABILITY

    I assume all risks and hazards incidental to participation including transportation to and from all activities. I hereby waive, release, absolve, indemnify, and agree to hold harmless the Charlotte Elite Wrestling Club, Elon Park Recreation Center, Charlotte-Mecklenburg County Parks and Recreations, its organizers, sponsors, supervisors, coaches, officers, participants, and/or other persons transporting myself or my child, except to the extent and in the amount covered by accident or liability insurance. I further agree to exercise proper care of any equipment and uniforms that may be provided for my child to use and will return it to the club in good repair at the end of the season. !!Parent!Signature___________________________________________!Date__________!!Wrestler!Signature________________________________________!Date___________!!!!

  • USA Wrestling Membership

    RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT WITH PARENTAL CONSENT ("AGREEMENT")

    IN CONSIDERATION of being permitted to participate in any way in any event ("Activity") at any time during the current calendar year I, for myself, my personal representatives, assigns, heirs, and next of kin:

    ACKNOWLEDGE, agree, and represent that I understand the nature of the Activity and that I am qualified, in good health, and in proper physical condition to participate in such Activity. I further agree and warrant that if, at any time, I believe the conditions to be unsafe, I will immediately discontinue further participation in the Activity.

    FULLY UNDERSTAND that: (a) THIS ACTIVITY INVOLVES RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS, AND DEATH ("Risks"); (b) these Risks and dangers may be caused by my own actions or inactions, the actions or inactions of others participating in the Activity, the conditions in which the Activity takes place, or THE NEGLIGENCE OF THE "RELEASEES" NAMED BELOW; (c) there may be OTHER RISKS or SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation ,or that of the minor, in the Activity.

    HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE the sanctioning organization(s), their administrators, directors, agents, officers, members, volunteers, and employees, other participants, officials, rescue personnel, sponsors, advertisers, owners and lessees of Premises on which the Activity is conducted, (each of the forgoing shall be considered one of the RELEASEES herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED, OR ALLEGED TO BE CAUSED, IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS; AND I FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, or anyone on my behalf, makes a claim against any of the Releases, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expenses, attorney fees, loss, liability, damage, or cost which may be incurred as the result of such claim.

    I ACKNOWLEDGE THAT I AM OVER THE AGE OF 18 YEARS, HAVE READ THIS AGREEMENT AND FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE, AND I INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID, THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.

    Minor Release

    AND I, THE MINOR'S PARENT AND/OR LEGAL GUARDIAN, UNDERSTAND THE NATURE OF THE ACTIVITY AND THE MINOR'S EXPERIENCE AND CAPABILITIES AND BELIEVE THE MINOR TO BE QUALIFIED, IN GOOD HEALTH, AND IN PROPER PHYSICAL CONDITION TO PARTICIPATE IN SUCH ACTIVITY. I HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS EACH OF THE RELEASEE'S FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON THE MINOR'S ACCOUNT CAUSED, OR ALLEGED TO BE CAUSED, IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE "RELEASEES" OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS AND FURTHER AGREE THAT IF, DESPITE THIS RELEASE, I, THE MINOR, OR ANYONE ON THE MINOR'S BEHALF MAKES A CLAIMS AGAINST ANY OF THE RELEASEES NAMED ABOVE, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES FROM ANY LITIGATION EXPENSES, ATTORNEY FEES, LOSS LIABILITY, DAMAGE, OR ANY COST THAT MAY OCCUR AS A RESULT OF ANY SUCH CLAIM.

    I acknowledge that I have had sufficient opportunity to review the provisions of this document and understand its purpose, meaning and intent, as well as the USA Wrestling Safe Sport Policy.

    Parent/Guardian Signature:_________________________________