CHAMPBUILDERS WRESTLING is a chartered member of the Illinois Kids Wrestling Federation (IKWF) and USA
Wrestling. CHAMPBUILDERS WRESTLING is designed to instruct and support young men of all skill levels in the
sport of wrestling. CHAMPBUILDERS WRESTLING is open to ALL Quad Cities wrestlers grades 1 - 8.
2014-2015 SEASON - REGISTRATION DATES
DATE: MONDAY OCTOBER 27TH, 2014
TIME: 5:30PM – 7:00PM
PLACE: U.T.H.S. Wrestling Room (Across from Boys Gym, North side of the High School).
DATE: TUESDAY OCTOBER 28TH, 2014
TIME: 5:30PM – 7:00PM
PLACE: GLENVIEW MIDDLE SCHOOL.
COST: $60.00 per wrestler. (Includes Wrestling instruction, t-shirt and USA Wrestling Card).
***PLEASE BRING: Copy of the wrestlers birth certificate is required for USA Wrestling Card.
Practice Schedule During the Year: FIRST PRACTICE IS MONDAY NOVEMBER 3rd. Every
Monday & Thursday. Grades 1-4 5:30pm-6:15pm & Grades 5-8 6:30pm-7:45pm @ UTHS
WRESTLING ROOM… except on Holidays & days of Varsity Wrestling Meets. TEAM will go to
open tournaments throughout the year. A schedule of practices and tournaments will be handed out
every month. If you can’t make the registration dates above, you can also register before any
practice.
CHAMPBUILDERS WRESTLING REGISTRATION
Name of Wrestler:__________________________________________________________________________
Address: _________________________________________________________________________________
Birth Date: __________________
T-shirt size:
Grade: _______________ Phone:________________________________
Youth – S M L Adult – S M L XL 2XL (circle one)
Parent’s e-mail address:_________________________________________________________________________
Emergency contact Name: ____________________________________Relationship: ________________________
Emergency contact Phone number:__________________________________________________________
Waiver: By signing this registration form, parent or legal guardian acknowledges and fully understands the possibility of injury
at this full contact sport wrestling club, and hereby assumes all responsibilities for medical bills as a result of any injury incurred.
The Champbuilders Wrestling Club, coaches and officials, and United Township High School (or any other practice facility used
by the Champbuilders Wrestling Club) are not responsible for any treatment or financial payment in the event of injury to the
athlete that may result from going to or participating with the Champbuilders Wrestling Club in practice or at events. Parents
will be contacted immediately upon injury. If life threatening, emergency services will be contacted.
Parent/Guardian Signature: _____________________________________________ Date: ____________________