Lynchburg Boys Lacrosse Clinic
Grades 2-8
Director:
Field Directors: Joe Starsia-Lasagna and
WHEN: July 7-10, 2008 Monday-Thursday
TIME: 5:00-7:30
WHERE: Lynchburg College Shellenberger Field
COST: $150 per person: Checks payable to:
Includes: FREE T-Shirt
CLINIC HIGHLIGHTS:
* Outstanding instruction from College coaches and players
-Drills to improve stick handling
-Team concepts through game-like situations
-Positional instruction at each session
-Scrimmages each session
-Play under the lights on the new FIELD TURF field
The clinic will be run by the
PLEASE REGISTER BY July 1, 2008
Pre-Registration is encouraged to help plan the specifics of the clinic.
Please mail to:
or e-mail to:
---------------------------------------------------------------------------------------------------------------------------------Name:
Address: (City, State, Zip)
Position:
Grade (As of Fall 2008):
Contact Phone Number:
Contact e-mail:
T-Shirt Size: YM_____ YL_____ AS____ AM_____ AL______ AXL_______
Amount Enclosed: _______________$150 Check (May pay in person first day of camp)
PLEASE FILL OUT INSURANCE AND WAIVER FORM AND ATTACH TO APPLICATION
RELEASE AND COVENANT NOT TO SUE
This is a legally binding release and covenant not to sue given by me,
__________________________________(print full name) to
In consideration for receiving permission to participate in the Lynchburg Boy’s Lacrosse Clinic, I am freely and voluntarily entering into this release and covenant not to sue.
I fully recognize that there are dangers and risks to which I may be exposed by participating
in the Lynchburg Boy’s Lacrosse Camp, July 7-10, 2008
Examples of these risks and dangers are : include the risk of catastrophic injury, paralysis and even death, as well as other damages and losses, associated with participation in a lacrosse event and related sports conditioning activities
I understand that
I therefore agree to assume and take on all of the risks and responsibilities in any way associated with this activity. In consideration of and return for being permitted to participate in this activity, and for the services, facilities and other things provided to me by Lynchburg College in this activity, I HEREBY RELEASE LYNCHBURG COLLEGE (and its trustees, employees or agents) FROM ANY AND ALL LIABILITY, CLAIMS AND ACTIONS THAT MAY ARISE FROM INJURY OR HARM TO ME, FROM MY DEATH OR FROM DAMAGE TO MY PROPERTY IN CONNECTION WITH THIS ACTIVITY. I UNDERSTAND THAT THIS RELEASE AND COVENANT NOT TO SUE COVERS LIABILITY, CLAIMS AND ACTIONS CAUSED ENTIRELY OR IN PART BY ANY ACTS OR FAILURE TO ACT OF LYNCHBURG COLLEGE (or its trustees, employees or agents), INCLUDING, BUT NOT LIMITED TO, NEGLIGENCE, MISTAKE OR FAILURE TO SUPERVISE BY LYNCHBURG COLLEGE.
I recognize that this release and covenant not to sue means I am giving up, among other things, rights to sue Lynchburg College for injuries, damages or losses that I may incur. I also understand that this release binds my heirs, executors, administrators and assigns as well as myself.
I have read this entire release and covenant not to sue, I fully understand it, and I agree to all of the terms and conditions as stated herein.
Participant Waiver (Signature is required in order to participate) In consideration of my participation in the Lynchburg Boy’s Lacrosse Clinic sponsored events and activities, I agree to the following:
1. Medical Attention: I hereby give my consent to the Lynchburg Boy’s Lacrosse Clinic to provide, through a medical staff of its choice, customary medical/athletic training attention, transportation and emergency medical services as warranted in the course of my participation in Lynchburg Boy’s Lacrosse Clinic’s sponsored or sanctioned events.
2. Readiness to compete: I will only participate in those conditioning or activities in which I believe I am physically and psychologically prepared to participate.
Participant Primary Medical Insurance Carrier: _______________________________ Policy #_______________________
Signature of Participant______________________________________________
FOR ANY PARTICIPANT WHO IS NOT YET 18 YEARS OF AGE: As a legal guardian of this participant, I hereby verify by my signature below that I have read and fully understand each of the above conditions for permitting my child to participate the Lynchburg Boy’s Lacrosse Clinic, and I accept each of the above conditions.
Signature of Guardian_____________________________
Printed Name____________________________________ Date_____________________________
