CHARLOTTE ELITE

Wrestling

2015
Charlotte Elite Wrestling Club
Registration Packet

Charlotte Elite

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

Coaching Staff:
Brian Thompson
(336) 682-3096
BrianThompsonAK@gmail.com

Chris Foy
(252) 814-4001
ChrisFoy@live.com

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 Wrestling Club Registration Form

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
PAYMENT INFO
CARD TYPE

VISA

AMEX

DISCOVERY

MASTERCARD

CARD NUMBER
EXPERATION DATE
CSV CODE
AUTHORIZATION SIGNATURE

* MONTHLY DUES WILL AUTOMATICALLY BE DRAFTED ON THE 7TH OF EACH

MONTH IF CASH OR CHECK HAS NOT BEEN RECEIVED*

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

Competitor

Elite

USAW Membership
Limited Liability

USAW Membership
Limited Liability

USAW Membership
Limited Liability

Insurance
Team Shirt
Team Shorts

Insurance
Team Shirt
Team Shorts
Team Wrestling Bag

Insurance
Team Shirt
Team Shorts
Team Wrestling Bag
Team Technique
Notebook
Team Singlet (FS/GR)

$65

$105

$235

+
2.) Membership Package: (select one)
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)

*6 Month Package paid in advance with registration

Example (New member registering with Essentials Pack)

1st Month

2nd Month

3rd Month

4th Month

1 Month

$185

$120

$120

$120

3 Months

$165

$100

$100

$100

6 Months

$605

1.) Registration Pack +

$65 (Essentials)

2.) Duration Pack =

$100 (3 Month)

Total
$165

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

!
!

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:_________________________________