2- DAY COMMUTER WRESTLING CAMP WITH KSU STAFF FEATURING
JOSH MOORE, KSU ASSISTANT COACH!!!
When: Monday, June 11th & Tuesday June 12th
Times: Youth (K-4th Grade)- 10 am to Noon both days.
5th-12th Grade- 10 am to Noon and 1 pm to 2:30 pm both days
Where: East Liverpool H.S.Gym, 100 Maine Blvd East Liverpool,OH 43920
*Cost: $60.00 for K-4th Grade.
$75.00 for 5th-12th Grade.
*Cost for East Liverpool wrestlers covered by boosters.
Questions? Call East Liverpool Head Coach Chad Hager @ (330) 303-8187
About Coach Josh Moore: Asst. Coach at Kent State University since 2004,
2X All American, and National runner-up for PSU, recently coached 7 NCAA National Qualifiers and MAC dual meet championship!
PRE-REGISTRATION: (Encouraged, but not required- forms available at the event).
Make checks payable to: EAST LIVERPOOL TAKEDOWN CLUB, INC.
Send to: East Liverpool Takedown Club, Inc.
c/o Wilma Williams, Treasurer
822 Orchard Grove
East Liverpool, OH 43920
FILL OUT ENTIRE REGISTRATION FORM FOR CONTACT REASONS:
Print Name(s)_____________________________________ Age(s)___________
Birth Date(s)____________Address________________________ ___ _______
City__________________ State___________ Zip ____________________
Grade _____ Phone # ___________________
School represented ______________ Working Email ______________________
LIABILITY RELEASE: I/we, the undersigned, individually and as a parent(s)/guardian(s) of________________________________ minor child/children, ask that he/ she be admitted to participate in the above “2 Day Commuter Camp with KSU Staff”. I/we do hereby agree to release, discharge and hold harmless the East Liverpool City School District, all camp clinicians including, but not limited to, Josh Moore, and any/all District Administrators or employees of all causes, liabilities, and damages, claims, or demands whatsoever on account of any injury or accident involving the said minor(s) arising out of the minor’s attendance at this wrestling camp or in the course of competition held in connection with this event.
Campers Printed Name(s) & Date___________________________ ___________
Campers Signature(s) & Date _____________________________ ___________
Parent(s)/Legal Guardian(s) Printed Name(s) & Date: __________________________________________________ ____ ___________
Parent(s)/Legal Guardian(s) Signature(s) & Date: __________________________________________________ ____ ___________
NOTICE: A signed Emergency Medical Form must be on file at the camp prior to participation and may be filled out and signed by the parent(s)/legal guardian(s) on site!
