Acknowledgment of risk and assumption of personal responsibility: I understand that during my participation in Maple Leafs Sports Camp I will be exposed to above-normal risk. I understand, too, that although Goshen College and sports camp personnel will take precautions to provide a safe environment, it is impossible to guarantee absolute safety. Also, I understand that I share responsibility for safety in the camp setting, and I assume that responsibility. I agree to verify with my physician that I have no physical or psychological problem that would prohibit participation in Maple Leafs Sports Camp. I agree to comply with the instructions and directions of all camp directors and supervisors. In the event of a medical emergency in which I cannot be reached, I authorize Goshen College and camp personnel to make appropriate medical decisions to ensure the best medical outcome for my child.
I have read the above statement and understand the nature of the physical demands of this activity. I therefore release any and all rights or claims for damages against Goshen College and camp personnel.
___________________________ Print Name
April 2-5, 2012 FOR MORE INFORMATION CONTACT: Goshen College Athletics 1700 S. Main St. Goshen, IN 574-535-7491 firstname.lastname@example.org
at GOSHEN COLLEGE
SPRING BREAK SPORTS CAMP at GOSHEN COLLEGE
April 2-5, 2012
Boys and Girls 2nd-5th grades
Goshen College Gym
Fun, skill development and exercise
$89 ($69 for additional siblings)
9am-3pm daily (lunch from 12:00-12:30pm. Bring your own lunch)
Camp T-Shirt Individual Instruction Guest coaches Lots of FUN
MULTI-SPORT FORMAT This camp will use a multi-sport format, in which campers can choose from a number of different sports to play and learn. Campers are encouraged to select sports they enjoy as well as those they may be interested in learning about.
CAMP REGISTRATION FORM Name___________________________________________ Age __________
Address _________________________________________ City ________________ State _______ ZIP code ________
Potential Sports (Please select at least 3 sports)
_____Baseball/Softball _____Basketball _____Gym games (dodge ball, tag , etc.) _____Kick ball _____Racquetball _____Rock Climbing _____Running (Track) _____Soccer _____Swimming _____Tennis _____Volleyball _____ Wii Fitness
Note: Selection of a sport does not guarantee enrollment, since availability of sports may be determined by number of participants interested. Campers may be placed in sports to create balanced numbers.
COACHES Campers will be coached by current Goshen College coaches and student athletes, focusing on skill development and having fun.
Current grade ______ Date of birth ___________________ T-shirt size: □ Youth M □ Youth L □ Adult S □ Adult M
□ Adult L
□ Adult XL
Emergency Contact:_______________________________ Phone number:___________________________________ Medical Conditions:________________________________ ________________________________________________
Parent/Guardian Signature:__________________________ Cost: $89 per camper $89 X ____=$______ $69 for each additional sibling $69 X ____ =$______ TOTAL=$______ Mail completed registration and check to:
Goshen College Sports Camp 1700 S. Main St. Goshen, IN 46526 ***See back for liability waiver