ENTRY FORM
             2010 - State Beach Wrestling Tournament
                          "BEAST OF THE BEACH"


Name:_________________________________________ Phone (with area code):____________________

Address:_____________________________ City:__________________ State:__________ Zip:_________

Email:_______________________________________________ (We will confirm pre-registration by email)


Division (circle one):     Middle School       High School       Open             Approximate Weight:____________

Emergency Contact Name:______________________________________ Phone(s):__________________

       - Pre-Registration with Payment (check only) must be received by Monday, July 19^th. 
       - Pre-registration entry fee is $15. Registration entry fee at tournament is $20 (cash or check only)...                              no AAU cards required, tournament is covered by Sports Event Insurance.

       - If participant is under 18 yrs. old, a Parent or Guardian must sign at bottom of registration form.
       - Participants must be present in competition dress and submit to a fingernail check and 
                  skin disease screening. Any skin problems that are questionable to the tournament staff or 
                  any official, whether the participant has a doctor’s note or not, will not be able to participate. 
       - A mouthguard must be worn with braces (to protect the other wrestlers).
       - In the event of injury or illness, no participant will be permitted to continue without approval from 
                   the medical staff.
       - The officials, tournament directors and/or the medical staff have full authority, without appeal, in 
                   determining the participation of the wrestler.

I understand and agree that the City of Port Huron, a Michigan Municipal Corporation, and Port Huron Northern High School /Port Huron Area School District and their employees, assume no responsibility for any injury or property damage or loss that might be suffered during the activity or program indicated (above) by the participant and/or Parent or Guardian and that the participant and/or Parent or Guardian assumes the risk for personal injury or loss or damage to property.  This event is run by the Port Huron Northern Wrestling team.

Signature of Participant (or Parent/Guardian if under 18)___________________________ Date_________

Where to Send Pre-Registration & Contact Information: 
            Northern Beach Wrestling Tournament
            c/o Russ Pickering (Tournament Coordinator)
            4895 Forman Drive, Fort Gratiot, Michigan  48059
            Phone: 810-385-5221,   Email: russ@pickeringbusiness.com   < best way to contact

            Make checks out to:     Port Huron Northern Wrestling


Location of Tournament: 
            Lakeside Park (3711 Gratiot Ave., Port Huron, Michigan). 
            Note: This is a public beach with restrooms (and public beach rules).

   Feel free to bring a picnic,and have fun!