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#190148 05/16/11 08:47 PM
Joined: Mar 2005
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Wrestle Like A Champ Camp!


Camp Staff: Curtis Chenoweth 2006 NAIA National Champion, 2X All American

Deadline – June 15th

Please mail your entry to:
PO Box 61
Clearwater, KS 67026
Or email: dad2greatboys@gmail.com

If emailing you must attach the filled out form
& bring signed copy the day of camp!

Class is limited to 30 participants!

Joe Johnson 2X NJCAA All American

Guy Johnson Clearwater High School Head Wrestling Coach

Michael Pelz Clearwater High School Assistant Wrestling Coach

Camp will touch all three different aspects of wrestling…takedowns, top control and bottom wrestling!

Please join us for a great day of education and fun!

When: Saturday June 18, 2011

Where: Clearwater High School Wrestling Room
1201 East Ross, Clearwater KS 67026

Cost: $25 with USAW Card
$62 without USAW Card

Registration begins at 9:00am
First Session: 9:30am – 11:30am
Lunch Break: 11:30am – 12:30pm
Second Session: 12:30pm – 2:30pm
Third Session: 3:00pm – 4:30pm

Participant Name:__________________________________ Age:______ Weight:______lbs


DOB:____/____/_______ USAW Card #_________________

Address ______________________ City/State/Zip________________________________

Emergency phone Number: (____)_____-______ Email_______________@______._____

Medical Insurance Co & Policy # ______________________________________________

Parent Name/Emergency Contact: _____________________________________________

Waiver: My son/daughter has been examined by a physician in the last year and is in good health. I hereby
authorize the Clinic Staff to act for me, according to its best judgment in any medical emergency and I hereby
waive and release said camp from any liability for injuries or illness incurred by my son/daughter while
attending camp. All information I have provided on this application is accurate.


PARENT SIGNATURE:_______________________________ DATE: _____/_____/_______

All participants must be picked up no later than 5:00pm

All questions and inquiries should be directed to:

Clint Luckner at (620) 584-4446 or (316) 650-9393 or dad2greatboys@gmail.com

A big THANK YOU to Clearwater High School for the use of their facility and to Clearwater
Youth Wrestling Club for providing lunch for the wrestlers, coaches and staff!


Curtis Chenoweth
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A link for the flier can be found on the high school or kids forum in the thread titled Wrestle Like a Champ Camp. I've helped Coach Ed and Miss Jenni out for several years now and have grown to really appreciate women's wrestling, and I would love to see some girls in attendance at this camp. If you have any questions you can contact Coach Luckner listed in the above thread or myself. Hope to see some girls there!

Curtis Chenoweth
phone- (316) 516-3801
email- curtischenoweth@gmail.com


Curtis Chenoweth
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