2008-2009
Chesapeake Bay Wrestling Application
Welcome to the Kent Islandyouth 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 WrestlingLeague 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
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:______
- WrestlersHome Phone #: ______Grade: _____
- WrestlersSchool:______
- Wrestlers Address:______
- Guardian/ParentCell #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: ______
WrestlersName :______(print)Parent/Guardian/Custodian:______(Sign and Date)
By signing any of the above, Guardian and wrestleragrees 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.