Illinois Coach

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    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.

    = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = =

    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:____________________