NHSCA (National High School Coaches Association)
National Open Wrestling Championships
Pennsylvania State Qualifier*

District IX

This form in .pdf format

Date: April 12 & 13, 2002 - Don’t miss this unique opportunity - Only NHSCA-PA Qualifier to feature
USA Olympian
Ken Chertow Mini-Camp - See back of flyer for complete details!

Schedule of events:     Date: April 13, 2002
Style &emdash; Scholastic/Folkstyle   Location: Clearfield Area Middle School, Mill Road, Clearfield
Registration and weigh-ins - Friday, April 12, 9:00-10:00 PM and Saturday, April 13, 7:30AM-9:00AM
Free Pre-Tournament Talk/Demo - Olympian Ken Chertow - 9:30-10:00 AM
Wrestling begins - Saturday, April 13, 10:00AM

Divisions and weight classes:

Uniforms - Singlets are required, however, you can not wear your school uniform

Matches:   High School Division - 2-2-2, consolations 1, 1, 1
           Middle School Division - 1, 1, 1 , consolations 1, 1, 1
           Elementary School Division - 1, 1, 1, consolations 1, 1, 1

Awards - Medals will be awarded to the top 4 place finishers in each weight class
*Qualifiers - Top 4 place finishers in each weight class advance to Nationals in Norfolk, VA, June 30-July 3.

Entry Form

Name ___________________________________________________ weight class ____________ grade ___________

Division: ______ high school (gr. 9-12) _______ middle school (gr. 7-9) _____ elementary (gr. 4-6) ______elem (gr 1-3)

Address _____________________________________ city, state, zip

Email address ______________________________ phone (           )

School ___________________________________ coach ___________________________________

Season record ____________ career record _______________ highest wrestling honors ___________________________

A $20 event / insurance fee should be mailed with this entry form to secure your spot in the NHSCA National Open Wrestling Championships State Qualifier

Championship shirt: include $10 on this entry form for an official T-shirt at a discounted price. Shirts will be distributed at registration. You may order more than one shirt. Indicate size: _______small _______ medium _______large ______ x-large _______ xx-large _________ total number of shirts in order

I have enclosed a check for $ __________________ which includes $20 for the event / insurance fee, (or $12.00 for grades 1-3 open tournament - non-qualifier) and the shirt order. Please make check payable to the NHSCA.

LIABILITY RELEASE I, the undersigned, individually and as a parent/guardian of, _____________________________________ a minor, ask that he/she be admitted to participate in the above NHSCA sponsored event. I do hereby agree to release, discharge and hold harmless the NHSCA, their agents and employees of and from all causes, liabilities, and damages, claims, or demands whatsoever on account of any injury or accident involving the said minor arising out of the minor’s attendance at the sporting event or in the course of competition held in connection with this event. I also give permission for my child’s photograph to appear in promotional material regarding this event.

PARENT/GUARDIAN SIGNATURE REQUIRED: _____________________________________________________

Please mail to: Cecilia Kyler, R.D. #1, Box 364 Clearfield, Pa. 16830
Questions: Cecilia Kyler at 814-765-1216 or ckyler@clearnet.net