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2008-2009

Chesapeake Bay Wrestling Application

Welcome to the Kent Island youth wrestling program “Chesapeake Bay Wrestling”. Our goal is to develop our Kent Island kids into self disciplined, well rounded athletes by participating in the “Worlds Oldest Sport”. CBW will be a seeding program for KIHS, tailoring our kids for the next level of competition in High School Wrestling. Wrestling is a very physical, emotional and demanding sport. We will be competing in the AACO Wrestling League with a County “A“ team for experienced kids and a County “B” team for first and some second year kids. The AACO Wrestling League is comprised of about 10 AACO teams, 1 QACO team (us), 1 Harford County team and 2 Howard County teams. Most, if not all of the matches will be held in AACO High Schools.

If you think you have what it takes and want learn more about this great sport, we invite you to apply.

Questions? Contact Coach: Rusty Smith 443-496-0701 or chesapeakebaywrestling@

Cost: is $110 made payable to Chesapeake Bay Wrestling

109 Baltimore Dr. Stevensville, MD 21666

General Info: (Print neatly)

• Wrestlers Name: ______________________________Age: _____

• Wrestlers DOB:_______________________Weight:_____________

• Wrestlers Home Phone #: _____________________ Grade: _____

• Wrestlers School:__________________________________________

• Wrestlers Address:_________________________________________

• Guardian/Parent Cell #1_________________#2_________________

• Guardian Relationship #1________________#2_________________

• Guardians Email #1___________________#2___________________

• Emergency Contact Name and #______________________________

Medical Information:

Preferred Doctor:___________________________Phone:_____________________

Preferred Hospital:___________________________Phone:____________________

Preferred Dentist____________________________Phone:_____________________

Insurance Carrier:___________________________

Policy #____________________

PART 1 - Medical Authorization: In the event reasonable attempts to contact the parents or guardian have been unsuccessful, I hereby give my consent for (1) the administration of any treat deemed necessary by preferred Doctor (2) or preferred Dentists or in the event designated Doctor or Dentist is not available, by another licensed physician or Dentist and (3) the transfer of the child to the preferred hospital or any hospital reasonably accessible. NOTE: This authorization does not cover major surgery unless the medical options of two other licensed Physicians or Dentists, concurring in necessity for such surgery are obtained BEFORE the surgery is preformed.

Wrestlers Name: ______________________________________ (print)

Parent/Guardian/Custodian_________________________(Sign and Date)

PART 2 – Refusal of consent –(DO NOT COMPLETE IF PART 1 IS COMPLETE)

I do NOT give consent for emergency treatment of my Child. In the event of illness or injury requiring emergency treatment, I wish that Chesapeake Bay Wrestling to take no action or perform the following Actions: _____________________________________________________________

Wrestlers Name :________________________________________(print) Parent/Guardian/Custodian:________________________(Sign and Date)

By signing any of the above, Guardian and wrestler agrees to return all issued equipment within 30 days at the close of wrestling season or will pay CBW $50 to replenish equipment. You also agree to release all coaching staff, aids, Anne Arundel County Wrestling League and Kent Island High School from any liability.

Practice Time: We are scheduled for practices starting in early Nov 2008 at KIHS on Tuesdays, Thursdays and Fridays from 7pm-8:30 pm. This is subject to change. Like last year, we will start the first year kids 2 weeks prior to experienced kids (until football is over), however experienced kids are welcome to come and start conditioning and drilling. All schedules and updates will be emailed Wrestlers and parents also agree to purchase a USA wrestling card required for all tournaments. Cost is $20-25.

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