Jerry Buckley CoEd Sports Camp

PERMISSION OF PARENT OR GUARDIAN The undersigned parent, guardian, or legal representative, hereby requests that _______________________(name of child) be allowed to participate in Buckley Coed Sports Camp and all of its associated activities. For and in consideration of the child being allowed to participate in this camp, and other valuable consideration, the undersigned parent, guardian, or legal representative on behalf of the child and the child's parents, personal representatives, assigns, heirs, and next of kin, do hereby release and hold harmless the Bishop Kenny High School, Inc.; Felipe J. EstĂŠvez, as Bishop of the Diocese of St. Augustine, a corporation sole; Buckley Coed Sports Camp; all organizers of this camp; all volunteers, chaperones, employees, and agents of the said parties; and their personal representatives or assigns from any loss or damage on account of any injury to the person or the personal property of the child, or death, caused by negligence or otherwise, while the said child is engaged in the above-stated camp and any of the activities of the camp. The undersigned expressly agrees that this release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted by the laws of the State of Florida and that if any portion of this agreement is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. The undersigned parent, guardian, or legal representative further acknowledges that he/she is authorized to enter this agreement on behalf of the child, the child's parents, personal representatives, assigns, heirs, and next of kin. I further authorize any representative of this camp to obtain medical treatment for my child in the unlikely event of an injury or illness during this program, and I agree to pay any expenses incurred for such treatment.

(Parent/Guardian/Representative) _______________________________________ (Date) _______________________________________ Jerry Buckley Coed Sports Camp is not affiliated or associated with Bishop Kenny High School, Inc.

Jerry Buckley Coed Sports Camp 2017 OPEN TO ALL BOYS AND GIRLS ENTERING 1ST – 6TH GRADES

Located at Bishop Kenny H.S. 1055 Kingman Avenue Jacksonville, Florida 32207 June 19-23, 2017 Cost: $125 Walkup Registration: $135 8:30 a.m. to 11:30 a.m.

CAMP OBJECTIVE The primary objective of the Jerry Buckley Coed Sports Camp is to have fun in team sports and age appropriate activities. Specific character traits and development will be focused on each day during camp.

CAMP STAFF Jerry Buckley enters his 12th season as the Head Boys’ Basketball Coach at Bishop Kenny HS. Coach Buckley has 22 years of coaching experience on the high school level. He is certified as a school counselor for grades K-12 and serves as the Director of Guidance Services at BKHS.

CAMP ACTIVITIES INCLUDE:       

Basketball Flag football Kickball Soccer Relay races Line Tag Softball

CAMP SCHEDULE: 8:30 8:45 9:15 9:30 10:15 10:30 11:15 11:30

Stretch/Character Trait of the Day

Session I Break/Rotate Activities Session II Break/Rotate Activities Session III Motivational Talk Camp Dismissal

Bishop Kenny student-athletes will serve as camp counselors.

CAMP MESSAGE We believe that our camp provides a unique opportunity for young people to have fun playing different sports. We have also seen the positive impact that sports can have in the development of a young person’s character and will encourage a team-oriented environment at our camp. Having fun and working together is what our camp is all about.

CAMP APPLICATION Name______________________________ Age_______________________________ Address____________________________ Zip_______Home Phone______________ School currently attending_____________ Grade entering 2017-18_______________ Parent’s Name_______________________ Email Address_______________________ Work Number_______________________ Cell Phone__________________________ Emergency Contact___________________ Insurance Company__________________ Policy Number ______________________ Coverage: PPO HMO Other T Shirt Size (circle one) Youth S M L Adult S M L Registration Information To register, please send  Application & Permission Release  Proof of insurance (photocopy of card)  Camp Fee ($125)  Check Payable to: Jerry Buckley Mail to: Jerry Buckley 9147 Timbermill Court Jacksonville, FL. 32256 Call Coach Buckley at 904-505-8173 for more information.