Monroe, Ohio Bronze Clinic
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Ted Witulski (USA Wrestling)
03/17/2003
BRONZE LEVEL COACH'S CLINIC & WRESTLING CLINIC featuring MATT HAMILL 3x NCAA Champion 2x World Champion U.S. Open Champion When: Saturday, April 5th Coach's Clinic registration at 7:30 a.m. Wrestling Clinic starts at 11:00 a.m. Where: Monroe High School Gym 101 W. Elm St. Monroe, OH 45050 Cost: Coaches Clinic: $60 Wrestling Clinic: $20 Cash or Check. Make checks payable to Monroe Wrestling Club Note: You must have a valid USA Wrestling coach's card for the Coach's Clinic. Cards will be available at registration for an additional cost of $30. Other: Release form (on back) MUST be signed (Elementary through High School) Questions: Contact Doug Howard Phone: (H) 937-748-8575 or (W) 513-425-3008 E-mail: doug.howard@AKSTEEL.com Directions to Monroe High School: TAKE I-75 TO EXIT #29 WHICH IS ST. ROUTE 63 (SAME AS TRADERS WORLD). GO WEST ON ST. ROUTE 63. GO APPROXIMATELY ONE MILE & TURN SOUTH (LEFT) ONTO MAIN STREET (INTERSECTION HAS TRAFFIC LIGHT). ON MAIN STREET GO TO 1ST TRAFFIC LIGHT & TURN WEST (RIGHT) ONTO ELM STREET. GO TO STOP SIGN AND GO STRAIGHT. YOU ARE NOW IN THE BACK PARKING LOT OF THE HIGH SCHOOL. GO AROUND THE WEST SIDE TO THE FRONT. THE GYM LOBBY IS THE FIRST SET OF DOUBLE DOORS. REGISTRATION NAME:_________________________ DOB:______ GRADE:_______________ WEIGHT:_____________ *************************************************************** MEDICAL RELEASE FORM In consideration of you accepting this registration, I, the undersigned, intending to be legally bound hereby for myself, my child, my heirs, executors and administrators, waive and release any and all claims for damage I may have against the Monroe Local School District, Monroe Wrestling Club, their agents and representatives and assigns for any and all injuries suffered by me or my child at said wrestling clinic. I further state that I shall not hold any of the above mentioned parties liable for any injuries which may occur while being transferred to and from the clinic. In the event my child(ren) are injured during the wrestling clinic, I give permission to seek and provide medical attention for my child. Please list any information concerning the child's medical history including allergies, medications being taken and any physical impairments to which we or a physician should be alerted to: _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ __________________________________________ ____________________ Signature of Parent/Guardian Date