IOWA STYLE WRESTLING CLINIC

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					       2007 SOMERS HIGH SCHOOL WRESTLING CLINIC
                                      July 23-26, JFK High School, Route 138, Somers, NY
                                                              CLINICIANS INCLUDE:

CLIFF MOORE- 2004 NCAA CHAMPION, THREE TIME IOWA STATE CHAMPION FROM THE
UNIVERSITY OF IOWA, 139-2 HIGH SCHOOL RECORD
LUKE EUSTICE- NCAA RUNER-UP, THREE TIME MINNESOTA STATE CHAMPION, FROM
THE UNIVERSITY OF IOWA




DEPOSIT AND BALANCE-A NON-REFUNDABLE deposit of $50.00 must accompany your application to insure your
enrollment. Please make checks payable to Somers USA Wrestling Club. Applications received after June 1 must be paid in
full.
TWO CLINICS WILL BE HELD SIMULTANEOUSLY- YOUTH CLINIC- Grades- 2nd to 6th, HS
CLINIC- Grades 7th to 12th.
COST
Clinic-                                                 $250        ______
Late fee if received after June 1st                      $10        ______
Amount Enclosed                                                     ______

You must have a valid USA Wrestling Card to participate.                                     To get a USA Wrestling card please register on
http://register.section1youthwrestling.com/

Send application to: Dennis DiSanto 14 Parkway Drive, Yorktown Heights, NY 10598 (914) 248-7219
                                     2007 SOMERS HIGH SCHOOL WRESTLING CLINIC
                                                     (Xeroxed copies accepted)
Last name____________________________________ First name____________________________________
Address_______________________________________________ City___________________________ State_____________
Zip_________________Parent/Guardian_________________________________________ Home Phone (____)_____________________
Work_(_____)___________________Weight__________________ Age_______________ Birthdate______________ 2007-08
Grade_________ HS Graduation Mo/Yr_________________ School_____________________________________________________
Do you have a valid USA Wrestling card? Yes__________No___________Card #_________________________
Youth Clinic____________HS Clinic_______________
Will you compete in the tournament Yes______ No________
Check Specific T-shirt Size: Small_____Medium_____Large_____ X-Large_____XX-Large_____

                                                         WAIVER AND HEALTH TREATMENT
As a condition of enrollment, the following Disclaimer of Liability must be signed by the Wrestler and his Parent/Guardian. The wrestler, in attending the 2007
Somers High School Wrestling Clinic and in using any clinic facility, does so at his own risk. The clinic and its staff shall not be liable for any damages arising
from personal injury sustained by the wrestler during the clinic or its facilities. The wrestler and his parent/guardian assume full responsibility for any damages or
injuries sustained by the wrestler during session and so hereby fully exonerate and discharge the Somers High School Wrestling Clinic, its staff, owners, employees,
and agents from any or all claims of damage. I verify that my son has been checked by a licensed physician in the past year and is physically able to participate in
the Somer High School Wrestling Clinic. I agree to allow my son to be treated by a licensed physician or nurse while attending if necessary and to assume all costs.
The Director may, at his discretion, dismiss any wrestler found in violation of clinic rules and regulations. Any wrestler dismissed from the clinic forfeits their
application fee and deposit.
                       Parent/Guardian signature___________________________________________

                      Wrestler signature_________________________________________________


                            E-mail: Coachdisanto@optonline.net/ Visit www.somerswrestling.com

				
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posted:9/9/2012
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