childrens clinic.pub
Print Name(s)
________________________________________________________
Signature of Parents/Guardian(s) Date:
________________________________________________________
Physician to Contact: Phone:
________________________________________________________
Second Person to Contact: Phone:
________________________________________________________
First Person to Contact: Phone:
I/We, the undersigned, consent to and authorize any medical professional and others working under their supervision to treat the above named child for any injury or illness arising from or related to my participation in the above named program. I/We further agree to pay any and all medical expenses, costs and other charges and to release and discharge and hold harmless the University of Hawai’i, State of Hawai’i, its officers, employees, agents, and assigns from and against any liability or any claims or demands arising from or connected with such medical IN CASE OF EMERGENCY: treatment or care.
MEDICAL CONSENT FORM
________________________________________________________
Print Name(s)
________________________________________________________
Signature of Parents/Guardian(s) Date:
I/We, the undersigned, certify that the above named child is in good physical health and is able to participate in all activities of the above named program. I/We also understand and acknowledge that there are inherent dangers and risks involved with participation in the above named program with the University of Hawai’i, which include, but are not limited to: dangers range from minor injuries, such as bruises, lacerations, strain, and sprains, to serious catastrophic injuries, including permanent disabilities and death, as well as property loss and severe social and economic losses. These risks include, but are not limited to, those caused by (a) the actions, omissions or negligence of other coaches, participants, competitors, volunteers, spectators; (b) conditions of the premises or equipment used; (C) rules of play; (d0 temperature; (e) weather; (f) conditions of participants or competitors. I understand that I/We should be covered during the Dates of Program above by a private medical and liability policy; and I/We further understand that the University of Hawai’i does not provide such insurance or otherwise indemnify individuals with respect to injuries or other liabilities arising out of participation in the above named program. Therefore, in consideration of the above named child being permitted to participate in the above named program, I/We hereby agree to assume all risks and responsibilities surrounding his/her participation in the above named program. I/We have read and understand any and all written materials setting forth the requirements for participation in the above referenced activity, as well as those explained by the instructor(s), and I/We agree to strictly observe them. Further, I/We do for myself, my heirs, executors, and administrators hereby accept full responsibility for my child’s participation and agree to indemnify, release and discharge the University of Hawai’i, State of Hawai’i, its officers, employees, agents, and assigns from any and all claims or actions for property damage, personal injury, and/or death arising from such participation in the above named program or growing out of or caused by any acts or omissions of the above named child during their participation in above named program.
ASSUMPTION OF RISK AND RELEASE
PROGRAM: 2009 HAWAII FOOTBALL SUMMER CAMPS
___________________________________________
Name of Child (Last Name, First Name, Middle Initial):
CONSENT/WAIVER FORM
UNIVERSITY OF HAWAI’I
For more information: Phone: (808) 956-6508 Fax: (808)-956-9552 E-mail: [email protected]
(Make checks payable to University of Hawaii) Email or Fax for RSVP. University of Hawaii Football Clinic 1337 Lower Campus Road Honolulu, HI 96822
HEAD COACH GREG MCMACKIN AND HIS STAFF INVITE ALL FOOTBALL PLAYERS TO ATTEND THE UNIVERSITY OF HAWAI'I 2009 SUMMER FOOTBALL CAMPS
2009 Hawai’i Football Summer Camps
Tony Tuioti Director of Player Personnel
Craig Stutzmann Graduate Assistant, WR’s
Nick Rolovich Quarterbacks Coach
Dave Aranda Defensive Line Coach
Special Teams Coordinator, DB’s
Chris Tormey
George Lumpkin Assistant Head Coach, DL
Gordy Shaw Offensive Line Coach
Brian Smith Running Back Coach
Associate Head Coach, DB’s
Rich Miano
Ron Lee Offensive Coordinator
Cal Lee Defensive Coordinator
Greg McMackin Head Football Coach
2009 COACHING STAFF
____________________________ ____________________________ ____________________________
Address: Address: City, State, Zip:
Monday through Wednesday
ACCEPTED
ALL WALK UP REGISTRATIONS MUST BE CASH OR MONEY ORDER, CHECKS WILL NOT BE
$60 is pre-registration price (checks received before June 17th). Fee will be $75 for all walk up registrations on the 22nd at the grass fields.
Clinic: 9:00-11:00 am
Registration: 8:00-9:00 am
Includes T-Shirt
Camp is for OL and DL
JUNE 22nd - 24th BIG MAN’S CAMP (ages 13 & UP) $60/ea
$80 is pre-registration price (checks received before June 11th). Fee will be $90 for all walk up registrations on the 16th at the grass fields.
Clinic: 9:00-11:00 am
For more information: Phone: (808) 956-6508 Fax: (808)-956-9552 E-mail: [email protected]
(Make checks payable to University of Hawaii) Email or Fax for RSVP. University of Hawaii Football Clinic 1337 Lower Campus Road Honolulu, HI 96822
NO SENIOR PROSPECT RULE.
TOTAL MONEY ENCLOSED_____________
T-SHIRT SIZE:____________ POSITION: _____ GRADE: ______
NAME:_________________________________ AGE:_________
T-SHIRT SIZE:____________ POSITION: _____GRADE: ______
NAME:_________________________________ AGE:_________
Registration: 8:00-9:00 am
Tuesday through Friday
Includes T-Shirt
T-SHIRT SIZE:____________ POSITION: _____GRADE: ______
Big Man’s Camp (13 & Up) $60/ea ($50/ea if 10 or more)
$80/ea
NAME:_________________________________ AGE:_________
T-SHIRT SIZE:____________ POSITION: _____GRADE: ______
NAME:_________________________________ AGE:_________
($60/ea if 15 or more)
Camp is for WR, DB, QB, RB, and TE
JUNE 16th - 19th SKILLS CAMP (ages 13&UP)
order when you register on Saturday June 13th
No Pre-Registration for Kids Camp. Bring Cash or Money
Skills Camp (13 & Up)
Clinic: 9:00-11:00 am
$80/ea
T-SHIRT SIZE:________ POSITION: ____
Registration: 8:00-9:00 am
GRADE: ______
NAME:_________________________________ AGE:_________
Saturday and Sunday
NAME:_________________________________ AGE:_________
Kid’s Camp (5-12 year olds) $40/ea
Camper’s Information
Phone Number 2: ____________________________
Phone Number: ____________________________
____________________________
Name:
Parental Information
T-SHIRT SIZE:________ POSITION: ______ GRADE: ______
$40/ea
______________________________
Head Coach: ______________________________
Team:
Registration Form
Includes T-Shirt
JUNE 13th & 14th KIDS’ CAMP (ages 5-12)
FOR ALL CAMPS BRING GRASS FOOTBALL SHOES OR TENNIS SHOES
2009 CAMPS
________________________________________________________
Signature of Parents/Guardian(s) Date:
________________________________________________________
Physician to Contact: Phone:
________________________________________________________
Second Person to Contact: Phone:
________________________________________________________
First Person to Contact: Phone:
I/We, the undersigned, consent to and authorize any medical professional and others working under their supervision to treat the above named child for any injury or illness arising from or related to my participation in the above named program. I/We further agree to pay any and all medical expenses, costs and other charges and to release and discharge and hold harmless the University of Hawai’i, State of Hawai’i, its officers, employees, agents, and assigns from and against any liability or any claims or demands arising from or connected with such medical IN CASE OF EMERGENCY: treatment or care.
MEDICAL CONSENT FORM
________________________________________________________
Print Name(s)
________________________________________________________
Signature of Parents/Guardian(s) Date:
I/We, the undersigned, certify that the above named child is in good physical health and is able to participate in all activities of the above named program. I/We also understand and acknowledge that there are inherent dangers and risks involved with participation in the above named program with the University of Hawai’i, which include, but are not limited to: dangers range from minor injuries, such as bruises, lacerations, strain, and sprains, to serious catastrophic injuries, including permanent disabilities and death, as well as property loss and severe social and economic losses. These risks include, but are not limited to, those caused by (a) the actions, omissions or negligence of other coaches, participants, competitors, volunteers, spectators; (b) conditions of the premises or equipment used; (C) rules of play; (d0 temperature; (e) weather; (f) conditions of participants or competitors. I understand that I/We should be covered during the Dates of Program above by a private medical and liability policy; and I/We further understand that the University of Hawai’i does not provide such insurance or otherwise indemnify individuals with respect to injuries or other liabilities arising out of participation in the above named program. Therefore, in consideration of the above named child being permitted to participate in the above named program, I/We hereby agree to assume all risks and responsibilities surrounding his/her participation in the above named program. I/We have read and understand any and all written materials setting forth the requirements for participation in the above referenced activity, as well as those explained by the instructor(s), and I/We agree to strictly observe them. Further, I/We do for myself, my heirs, executors, and administrators hereby accept full responsibility for my child’s participation and agree to indemnify, release and discharge the University of Hawai’i, State of Hawai’i, its officers, employees, agents, and assigns from any and all claims or actions for property damage, personal injury, and/or death arising from such participation in the above named program or growing out of or caused by any acts or omissions of the above named child during their participation in above named program.
ASSUMPTION OF RISK AND RELEASE
PROGRAM: 2009 HAWAII FOOTBALL SUMMER CAMPS
___________________________________________
Name of Child (Last Name, First Name, Middle Initial):
CONSENT/WAIVER FORM
UNIVERSITY OF HAWAI’I
For more information: Phone: (808) 956-6508 Fax: (808)-956-9552 E-mail: [email protected]
(Make checks payable to University of Hawaii) Email or Fax for RSVP. University of Hawaii Football Clinic 1337 Lower Campus Road Honolulu, HI 96822
HEAD COACH GREG MCMACKIN AND HIS STAFF INVITE ALL FOOTBALL PLAYERS TO ATTEND THE UNIVERSITY OF HAWAI'I 2009 SUMMER FOOTBALL CAMPS
2009 Hawai’i Football Summer Camps
Tony Tuioti Director of Player Personnel
Craig Stutzmann Graduate Assistant, WR’s
Nick Rolovich Quarterbacks Coach
Dave Aranda Defensive Line Coach
Special Teams Coordinator, DB’s
Chris Tormey
George Lumpkin Assistant Head Coach, DL
Gordy Shaw Offensive Line Coach
Brian Smith Running Back Coach
Associate Head Coach, DB’s
Rich Miano
Ron Lee Offensive Coordinator
Cal Lee Defensive Coordinator
Greg McMackin Head Football Coach
2009 COACHING STAFF
____________________________ ____________________________ ____________________________
Address: Address: City, State, Zip:
Monday through Wednesday
ACCEPTED
ALL WALK UP REGISTRATIONS MUST BE CASH OR MONEY ORDER, CHECKS WILL NOT BE
$60 is pre-registration price (checks received before June 17th). Fee will be $75 for all walk up registrations on the 22nd at the grass fields.
Clinic: 9:00-11:00 am
Registration: 8:00-9:00 am
Includes T-Shirt
Camp is for OL and DL
JUNE 22nd - 24th BIG MAN’S CAMP (ages 13 & UP) $60/ea
$80 is pre-registration price (checks received before June 11th). Fee will be $90 for all walk up registrations on the 16th at the grass fields.
Clinic: 9:00-11:00 am
For more information: Phone: (808) 956-6508 Fax: (808)-956-9552 E-mail: [email protected]
(Make checks payable to University of Hawaii) Email or Fax for RSVP. University of Hawaii Football Clinic 1337 Lower Campus Road Honolulu, HI 96822
NO SENIOR PROSPECT RULE.
TOTAL MONEY ENCLOSED_____________
T-SHIRT SIZE:____________ POSITION: _____ GRADE: ______
NAME:_________________________________ AGE:_________
T-SHIRT SIZE:____________ POSITION: _____GRADE: ______
NAME:_________________________________ AGE:_________
Registration: 8:00-9:00 am
Tuesday through Friday
Includes T-Shirt
T-SHIRT SIZE:____________ POSITION: _____GRADE: ______
Big Man’s Camp (13 & Up) $60/ea ($50/ea if 10 or more)
$80/ea
NAME:_________________________________ AGE:_________
T-SHIRT SIZE:____________ POSITION: _____GRADE: ______
NAME:_________________________________ AGE:_________
($60/ea if 15 or more)
Camp is for WR, DB, QB, RB, and TE
JUNE 16th - 19th SKILLS CAMP (ages 13&UP)
order when you register on Saturday June 13th
No Pre-Registration for Kids Camp. Bring Cash or Money
Skills Camp (13 & Up)
Clinic: 9:00-11:00 am
$80/ea
T-SHIRT SIZE:________ POSITION: ____
Registration: 8:00-9:00 am
GRADE: ______
NAME:_________________________________ AGE:_________
Saturday and Sunday
NAME:_________________________________ AGE:_________
Kid’s Camp (5-12 year olds) $40/ea
Camper’s Information
Phone Number 2: ____________________________
Phone Number: ____________________________
____________________________
Name:
Parental Information
T-SHIRT SIZE:________ POSITION: ______ GRADE: ______
$40/ea
______________________________
Head Coach: ______________________________
Team:
Registration Form
Includes T-Shirt
JUNE 13th & 14th KIDS’ CAMP (ages 5-12)
FOR ALL CAMPS BRING GRASS FOOTBALL SHOES OR TENNIS SHOES
2009 CAMPS
