PANTHER FREESTYLE
WRESTLING CLUB
COACH: BRAD HARRIS
Head Wrestling Coach – Pickerington North
3X State Placer
Ohio High School State Champion
3rd Senior High School Nationals
3rd Freestyle Junior Nationals
DI College National Qualifier
LOCATION: PICKERINGTON NORTH HS - Wrestling room
7800 REFUGEE RD.
DAYS/TIME: Mondays & Wednesdays MARCH 21st - MAY 25th
6:00-7:30
FEES: $65 may be paid in check or cash. Checks made out to Brad Harris.
USA Wrestling Card – You will need to purchase a USA Wrestling membership prior to the start of the club. It can be purchased at
http://www.usawmembership.com. This will be required for all freestyle competition and offers the wrestler and club insurance.
Contact: Brad Harris h-(614) 829-7848 cell (614) 404-9504
6469 Crab Apple Dr
Canal Winchester, OH 43110
REGISTRATION FORM
WRESTLER NAME __________________________________ BIRTH DATE_______________
ADDRESS_________________________ CITY, ZIP________________________
PHONE _______________ GRADE ____WEIGHT _______SCHOOL ________________
EMERGENCY NUMBER (OTHER THAN ABOVE #) __________________________________
MEDICAL CONDITIONS _______________________________________________________
______________________________________________________________________
I AUTHORIZE THE CLUB DIRECTOR AND/OR STAFF TO ACT IN MY BEHALF REGARDING ANY SITUATION REQUIRING DISCIPLINE OR MEDICAL ATTENTION. MY CHILD IS PHYSICALLY FIT TO PARTICIPATE IN THIS CLUB, ACCORDING TO OUR FAMILY DOCTOR.
I HAVE LISTED ABOVE ANY CONDITIONS THE STAFF SHOULD BE AWARE OF. I UNDERSTAND THERE IS THE POSSIBILITY OF INJURY TO MY CHILD.
PARENT PRINTED NAME _________________________________
PARENT SIGNATURE ___________________________________DATE______________
pickpanther;706027 wrote:PANTHER FREESTYLE
cruiser_96;706159 wrote:Okay. Whatever you want to believe. Whatever helps you sleep at night. But we (you and me) know the truth. And to that, I say thanks.