Atlas Wrestling Club
Spring 2004
Mission:
To produce World and Olympic Champions
Objective: To help athletes to reach their highest possible potential and
goals.
Location: Sacred
Dates and Time: Tuesday, Wednesday and Thursday evenings.
March 23 through June
17, 2004, 6:00-7:30pm.
Eligibility: Any male or female wrestler with the desire to learn proven
championship technique and training methods used by World and Olympic
Champions.
Fees: $175 covers all sessions. A USA Wrestling card is required ($30).
Staff:
Andy Seras-Sacred Heart University Wrestling Coach,
2004 USA Olympic Team Coach, Head Coach 2002 USA Greco-Roman World Team, 2001
USA Wrestling Greco-Roman Coach of the Year, Head Coach 2001 & 2003 USA
Greco-Roman World Cup Team, Assistant Coach 2001 USA Greco-Roman World Team,
1988 USA Greco-Roman Olympic Team, 5x USA Greco-Roman World Team member, 2x Pan
American Greco-Roman Champion, 1994 Greco-Roman World Cup Champion, 5x National
Open Greco-Roman Champion (2 time OW), 1985 NCAA Division III Champion, 4 time
NCAA Division III All-American, Distinguished Member NWCA Division III Hall of
Fame, Distinguished Member University at Albany Athletic Hall of Fame
Paul Musso-Sacred Heart University Assistant
Wrestling Coach, Former Head Coach at New Fairfield HS and Cheshire HS, Head
Coach CT Cadet and Junior National Team 1999-2002
Jeremy Kelly-Sacred Heart University Assistant Wrestling Coach and recruiting
coordinator, Fairfield Youth Program Coach
Jason Cucolo- Sacred Heart University 2003 graduate,
2x NCAA Division One qualifier, University Nationals GR All-American, 2002 CAA
Champion.
Please make checks payable to Sacred Heart University-Wrestling
(USA CARDS to Andrew Seras)
Please refer any questions to Andrew Seras 89
Berkshire Rd. Sandy Hook, CT 06482 or call at (203)426-8230.
E-mail-aseras@charter.net
Parental Consent
Form
Name_____________________________________________Grade__________Phone_____________________
Parent’s
Names______________________________________________________________________________
Home
Address______________________________________________________________________________
City_____________________________________________ State _______________ Zip
code______________
High School_____________________________________
Coach______________________________________
**Parental Consent
Athlete’s Name______________________________________________________________Date____________
We insist that your child have a physical exam prior to attending this clinic
series.
The above named athlete was examined by a physician, at least one year prior to
the starting date of the clinic and was found to be in good health and able to
participate in wrestling activities without any restrictions.
The above athlete has the following health problems :( Drug allergies,
diabetes, or other problems that need to be known to the staff)
__________________________________________________________________________________________
Parent’s Signature ____________________________________________________Date
____________________
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NAME______________________________________________DATE OF
BIRTH_______________________
STREET___________________________________________________________________________________
CITY_________________________________________
STATE______________________ZIP_____________
TELEPHONE_______________________________________2002-2003 USAW
CARD#__________________
Waiver and Release
from Liability
1. I,
________________________the undersigned, on behalf of myself, my heirs, and
next of kin, personal representatives, agents, insurers, successors and assigns
(all hereinafter "Releasors") hereby
FOREVER RELEASE, DISCHARGE AND COVENANT NOT TO SUE THE UNITED STATES OF AMERICA
WRESTLING ASSOCIATION, INC., its insurers, its affiliate clubs, administrators,
agents, directors, officers, state organizations, members, committees,
volunteers, all employees of USA Wrestling, and any and all participants,
officials, referees, coaches, host clubs, sponsoring agencies, sponsors,
advertisers, local organizing committees (and if applicable) owners, lessors, and operators of premises used to conduct any USA
Wrestling sanctioned event, meet, practice or activity (all hereinafter "Releasees") from any and all liabilities, claims,
demands, causes of action or losses of any kind or nature, past, present or
future, direct or consequential that I may hereafter have for PERSONAL INJURY,
PERMANENT, TEMPORARY, TOTAL OR PARTIAL DISABILITY, DISFIGUREMENT, PARALYSIS AND
ANY OTHER LOSSES OR DAMAGES TO PERSON OR PROPERTY OR DEATH, arising out of my
participation in, attendance at or traveling to and from any USAW wrestling
sanctioned event or activity including, but not limited to, LOSSES CAUSED BY
THE PASSIVE OR ACTIVE NEGLIGENCE OF THE RELEASEES, or hidden, latent or obvious
defects in the facilities or equipment used.
2. Releasor understands and acknowledges that
3.Releasor acknowledges and fully understands that each participant in any USA
Wrestling sanctioned event, meet, practice or activity, including Releasor, will be engaging in activities that involve risk
of serious injury, including permanent, temporary, total or partial disability,
disfigurement, paralysis and other losses to person or property, including
death, and that severe social and economic losses may also result not only from
Releasor's own actions, inactions or negligence, but
also from the actions, inactions or negligence of others notwithstanding the
rules of play or the condition of the premises or of any equipment used.
Furthermore Releasor acknowledges and fully understands
that there may be other associated risks with such activities which are not
known or not reasonably foreseeable at this time.
I ACKNOWLEDGE THAT I HAVE HAD SUFFICIENT
________________________________________________________________________________
_________________
(Participant's Signature) (Print Name) DATE
The undersigned ______________________ does hereby represent that he/she is, in
fact, the parent or guardian of
___________________________,
and acting in such capacity, agrees to the terms and conditions of the above
stated waiver and release.
____________________________ ____________________________________ ________________________
(Print Name) Date (Signature of Parent or Guardian) (Relationship to minor)