2006 Carbondale Kids Open
Wrestling Tournament
“The DOG FIGHT”
IL Midget State Qualifier - USA SANCTIONED
DATE: Sunday, February 12, 2006
LOCATION: Carbondale Community High School
1301 E. Walnut Street & Giant City Road (Gym Entrance off Giant City Rd)
ENTRY FEE: $15. Pre-registration only. No entries at-the-door. Coaches may fax a roster of
wrestlers prior to the DEADLINE: 10:00 p.m. on Thursday, February 9th, 2006. If a roster is faxed,
then your Head Coach is responsible for payment for all wrestlers on the roster and must bring signed
waiver forms for each wrestler. (Make checks payable to: Carbondale WC)
Weights: Faxed Weights Only!!
Fax: 618-549-4112 Or Email: jerry@siu.edu
Check-in: 7:00 a.m. - 8:00 a.m.
Start Time: Wrestling to begin at approx. 9:15 a.m. Approximate End Time: 3 p.m.
Awards: Trophys 1st thru 4th, Medals 5th thru 6th Place. Bracket board for 1st Place.
Brackets: Blocked. 8 brackets when possible. Periods 1-1-1 (10 and under) 1-1.5-1.5 (11 and up)
Age Groups: 6 & under, 7-8, 9-10, 11-12, 13-14
Concessions: Food & Drink available all day.
Admission: $2.00 Adults $1.00 Children $5.00 for family 5 and under free
Questions: Jerry Richards Phone: 618-684-4785 (jerry@siu.edu)
Dennis Ragan Phone: 618-687-3509 (ragan1@bnjinternet.net)
Rosters: Fax or email team LEGIBLE rosters w/ Name, Weight, Record, Ranking, USA Card#, Birthday
& Age Group to: Fax: 618-549-4112 Email: jerry@siu.edu
All wrestlers must have a signed waiver form turned in before they will be allowed to wrestle.
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ENTRY FORM: Carbondale Dog Fight Wrestling Tournament
NAME:_________________________________________________ PHONE #____________________
TEAM:_________________________________________________
Record (W-L): ___________________
Ranking: ____ (1=State Placer, 2=State Qualifier, 3=Experienced, 4=Novice,5=1st Year)
USA CARD #________________________
AGE: __________BIRTHDATE:(M/Y)______________________________
AGE GROUP: (circle one) 6 & U 7 & 8 9 & 10 11 & 12 13 & 14
In consideration of your acceptance of this entry, I intend to be legally bound hereby for myself, my heirs, executors and
administrators waive and release the Carbondale Wrestling Club, IKWF, THEIR AGENTS, REPRESENTATIVES,
COMMITTEES, FROM ANY AND ALL CLAIMS OR RIGHTS TO DAMAGE FOR INJURIES OR LOSSES SUFFERED
BY ME DIRECTLY OR INDIRECTLY IN TRAINING OR TRAVELING TO OR FROM OR COMPETING IN, OR
ATTENDING The Carbondale Dog Fight Wrestling Tournament.
Guardian’s Signature__________________________________________ Date:____________________