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AREA
XII
2014 AREA XII PJW YOUTH CHAMPIONSHIPS
TUNKHANNOCK HIGH SCHOOL
135 Tiger Drive
Tunkhannock , PA 18657
DATE: Sunday, February 16th, 2014
Weigh-Ins: Saturday - 2/15/2014 from 3 PM to 5 PM (During TYWC’s T Stanton Memorial Round Robin) or Saturday - 2/15/2014 from 3 PM to 4:15 PM Hazleton High School
or Sunday - 2/16/2014 from 7 AM to 8 AM Tunkhannock High School
Wrestling Start Time: 9:00 AM
Tournament Director & Area XII Chairman: Gary Siegel - 570-574-5678 e-mail: garys@goldenbusiness.com
Alternate Chairman: Tom Traver – 570-239-4934 e-mail: ttraver@dallassd.com
Registration: On line at http://wrestlereg.com – Deadline for online entry is Thursday, February 13th.
Mail entry form to Gary Siegel – 1014 Village Road, Falls, Pa 18615
Mail in forms must be postmarked no later than Monday, February 10th
PRE-REGISTRATION ONLY ** NO WALK IN REGISTRATIONS ACCEPTED
Web Sites for Additional information: PJW AREA XII | WVCD2.COM, www.rakinfo.com/pennleague, www.pywrestling.com, www.PAJW.org
Entry Fee: Mail in = $25.00 Make Check payable to PJW AREA XII, On-line wrestlereg = $27.00
Admission: Adults - $7.00 Students - $4.00 Hot food and drinks available.
Awards will be awarded to 1st – 2nd – 3rd Place Finishers
1st and 2nd Place Advances to the Youth State Championship, March 21st & 22nd at The Pa Farm Show Complex in Harrisburg, Pa.
PJW RULES
1) Wrestler must reside in one of the following counties:
Bradford, Lackawanna, Luzerne, Pike, Susquehanna, Wayne and Wyoming.
2) Wrestler may only submit 1 Entry Form.
3) Age as of December 31st, 2013.
4) PJW and PIAA rules apply to all applicants, coaches and spectators.
5) A 11 and 12 year old on a Jr. High roster may choose only 1 PJW tournament series (Youth or Jr. High).
6) No weight changes permitted after entry form has been submitted.
7) Wrestlers not making weight at weigh in will forfeit their entry without refund.
8) Birth Certificate and proof of residency of both wrestlers must be provided if challenged.
9) All entrants must be willing to represent Area XII at the PJW Youth State Finals in Harrisburg.
10) Advancing wrestlers must complete advancement process prior to leaving the tournament.
11) Advancing wrestlers will be required to pay a refundable $70.00 deposit for singlet use prior to leaving tournament.
12) Advancing wrestlers must provide a copy of Birth Certificate prior to leaving tournament.
13) All Bout times are 2-1-1. Overtime is 1 minute sudden death, then 30 second ride out if needed.
14) Suitable undergarment must be worn for weigh in.
15) Head gear is required, shoe laces must be secured, PIAA hair rule applies, and mouth guard is required to cover braces.
16) Seeding will be determined by tournament committee and information provided.
17) Full double elimination format with wrestle back for true second.
18) Application must be completed in its entirety.
19) Release and Waiver of Liability Agreement & Participant Code of Conduct form must be completed and brought along to weigh in or mailed with entry form.
20) Failure to comply with any PJW or PIAA rule will result in disciplinary action and/or forfeiture of participation.
AREA
XII
2014 AREA XII PJW YOUTH CHAMPIONSHIPS
TUNKHANNOCK HIGH SCHOOL
135 Tiger Drive
Tunkhannock , PA 18657
ENTRY FORM
Name: __________________________________Phone Contact # (___) _____- ______
Full Address:
Street ________________________________City:_________________ Zip: _______
e-mail: ____________________________________________Age_______________
School District: (no clubs) ______________________________________
County of Residence: _______________________ Birth Date: _________________
***Please circle the Weight class you are entering. ***
8 and Under: 45 50 55 60 65 70 80 110
9 & 10 YR OLD: 55 60 65 70 75 80 85 90 95 105 120 150
11 & 12 YR OLD: 65 70 75 80 85 90 95 100 105 115 125 135 145 160 200
This year (2013-2014) Record: Wins: ___________ Losses: ___________
HONORS: _____________________________________________________
__________________________________________________________________
Last year (2012-2013) Record: Wins: ___________ Losses: __________
HONORS: _____________________________________________________
________________________________________________________________
I hereby state that all information provide on this entry form is correct and I understand that by falsifying any information will result in forfeiture of my entry. I agree to abide by all PJW and PIAA rules while participating in the 2014 PJW Events.
Wrestlers Signature _________________________________Date:____________
Parent, Guardian or Coaches Name: _____________________________________
Parent, Guardian or Coaches Signature: ______________________Date:________
Application MUST be COMPLETE and SIGNED. This form may be duplicated.
THIS PAGE MUST BE COMPLETED AND BROUGHT TO WEIGH IN OR MAILED WITH ENTRY FORM.
RELEASE AND WAIVER OF LIABILITY AGREEMENT & PARTICIPANT CODE OF
CONDUCT
I,_______________________, acknowledge that I have voluntarily applied to participate in the
(Entrants full name)
Pennsylvania Junior Wrestling (PJW) Tournament. I am aware that these activities may be hazardous and that I could be seriously injured. I am voluntarily participating with knowledge of the danger involved, and agree to assume any and all risks of bodily injury, or death, whether those risks are known or unknown.
I verify this statement by placing my initials here: ___ ___ Parent or Guardian’s initials: ___ ___
As consideration for being permitted by PJW, and any owner, administrator, tournament director,
chairperson of the premises holding any of the events, to participate in these activities and use the premises and facilities, I forever release PJW or any Lessor or any PJW affiliated organization, and their respective directors, officers, employees, volunteers, agents, contractors, and representatives (collectively “Releasees”) from any and all actions, claims, or demands that I, my assignees, heirs, distributees, guardians, next of kin, spouse and legal representatives now have, or may have in the future, for injury, death, or property damage, related to (i) my participation in these activities, (ii) the negligence or other acts, whether directly connected to these activities or not, and however caused, by any Releasee, or(iii) the condition of the premises where these activities occur, whether or not I am then participating in the activities. I also agree that I, my assignees, heirs, distributees, guardians, next of kin, spouse and legal representatives will not make a claim against, sue, or attach the property of any Releasee in connection with any of the matters covered by the foregoing release.
I have carefully read this agreement and fully understand its contents. I am aware this is a release of liability and a contract between myself and PJW, and the lessors, and sign it of my own free will. When Signed by Parent or Guardian: I recognize the dangers of the activities and the significance of this Release and Waiver were explained to the Participant and that the Participant understood them, or I, as parent of the Participant, understand them.
While participating in PJW activities, the Participant will be supervised by ________________.
(Coach or Parent’s name)
I understand the Tournament Director, under the guidance of the PJW rules and administration, may withdraw our son/daughter from any Tournament if he/she is involved in behavior or activity deemed to be detrimental to the health, safety or welfare of other participants, spectators, tournament staff, or tournament sites; or if involved in actions considered to be detrimental to the goals and objectives of PJW or in violation of the PJW Code of Conduct. We have read and agree with the tournament rules as listed on the information page.
_____________________________________ _______________________
Parent/ Guardian Signature Date Signed
_____________________________________ _______________________
Contestant Signature Date Signed
THIS PAGE MUST BE COMPLETED AND BROUGHT TO WEIGH IN OR MAILED WITH ENTRY FORM.
PJW AREA XII
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