EAST LIVERPOOL TAKEDOWN CLUB OPEN WRESTLING MATS
Who: JH & High School Wrestlers-Mondays & Wednesdays from 3:30-5:30 pm.
Youth (K-6th grade)-Mondays & Wednesdays from 5:30-6:30 pm.
Where: East Liverpool H.S. Wresting Room, (next to main gym),
100 Maine Blvd., East Liverpool, Ohio 43920
Questions?:
Call East Liverpool Takedown Club Coach Shilling @ (330) 301-4872

What to Bring?
Wrestling gear: Wrestling shoes or non-street shoes, sweats, shorts,
fitted shirt, extra clothes. (Extra wrestling shoes may be borrowed).
Headgear-Recommended.
A work-out partner-optional, but guarantees a work-out.

[Extra Forms available at East Liverpool Open Mats]

FILL OUT ENTIRE REGISTRATION FORM FOR CONTACT REASONS:
Print Name(s)_____________________________________ Age(s)___________
Birth Date(s)____________Address________________________ ___ _______
City__________________ State___________ Zip ____________________
Home Phone # _________________ Emergency Phone #:____________________

INJURY WAIVER & RELEASE

I/we, the undersigned, parent(s)/guardian(s) of________________________________
minor child/children, ask that he/ she be admitted to attend and/or participate in the above
East Liverpool Takedown Club Open Mats. I/we do hereby agree to specifically release,
discharge and hold harmless the East Liverpool Takedown Club, the East Liverpool City
School District, including, but not limited to, and any/all District Administrators,
employees, supervisors, officers, directors, and volunteers of any and all financial
responsibilities, 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 and/or participation at East Liverpool Open Mats or in the course of
competition held in connection with this event.

I/we certify that injuries, which might be sustained by our minor child/children as a result
of participation, are covered by our family insurance.

PARENT/GUARDIAN SIGNATURE:_______________________Date:___________