Gannon University Women's Lacrosse
Gannon University Women’s Lacrosse Saturday September 30, 2017 High School Girls In Grades 9-12 11:00am-1pm Gannon University Recreation & Wellness Center
CLINIC APPLICATION
GENERAL INFORMATION
CLINIC DIRECTOR
Mission Statement:
Kerry O’Donnell Head Coach – Gannon University
Gannon University has established a reputation for excellence both on and off the lacrosse field. The GU Women’s Lacrosse staff and players will provide young female athletes with the same instruction and approach that has helped our own players achieve success. This is your chance to become a part of the Gannon University tradition. Sign up today!
STAFF
Staff will include current players from the Gannon University Women’s Lacrosse Team.
AGES
Girls in grades 9 through 12 are invited on Saturday September 30 from 11am to 1pm.
Participants Name: _________________________________________ Age:____ Grade: ______Yrs experience: ______ Address: ________________________________ City: _____________ State: _______ Zip: ______ Grade: ___ Position: ______ Club Team:_______ School: _______________________________
Our primary purpose of the clinic is to teach Parent’s Name__________________________ COST fundamental skills while developing stick skills and strong game awareness. With these goals in mind, we $50 dollars to register! Cash or check made payable to Email address:__________________________ strive to develop the athlete’s ideas in sportsmanship, Gannon Women’s Lacrosse leadership, and citizenship. Emergency Contact (with Phone number): RULES AND REGULATIONS _______________________________________ Our goal of the clinic is to teach and reinforce skills in a Each athlete will be expected to comply with rules for fun but structured setting. The camp will be gratifying the camp and must follow instructions given by the SIGNATURE OF PARENT OR GUARDIAN clinic director and instructors. Any violation or abuse of _______________________________________ and worthwhile experience for every participant. clinic rules will result in immediate dismissal from the camp without a refund. ARRIVAL & DEPARTURE OF PLAYERS Does your child have any special medical needs we should be aware of? YES / NO Athletes should report to Gannon University Recreation and Wellness Center at least 15 minutes If so, please explain: _________________________________________ prior to start for on-site check in! Athletes will be dismissed on time and should be picked up at the Rec SPECIAL INSTRUCTIONS Center. Parking is available immediately in front of the An athlete who has specific medical instructions should building.
Items Needed for Clinic:
Stick Goggles Mouth guard Sneakers Water
provide a note from parent or guardian. Please send this information in with application.
INSURANCE INFORMATION: please provide a photo copy of your insurance card. Our athletic training staff will need a copy of your insurance card, both front and back, to keep on file while you participate in our clinic!
Waiver of Release of Liability and Assumption of Risk Agreement This document pertains to the athletic event on the premises of Gannon University or any athletically related field where an event may occur in conjunction with the Gannon University Athletic Department. I acknowledge and fully understand that ________________________________ will be engaging in activities that involved risk of serious injury and that may cause severe social and economic losses which may result not only from their own actions, inactions or negligence of others, the rules of play, or the condition of the premises or of any equipment used. Further, that there may be other risks not known or not reasonably foreseeable at this time. My signature releases, waives, discharges and absolves Gannon University from any responsibility pertaining to the aforementioned. My signature also provides consent for my child to receive medical care by the event’s Certified Athletic Trainer and for emergency medical decisions to be made in my child’ best interest. I have read the above waiver, release and understand it. I also understand that I have signed this document voluntarily, intelligently and with full knowledge of its legal consequences as the guardian for ________________________________________________.
___________________________________ ______________________________ Guardian Name (Please Print) Guardian Signature
_____________ Date
Emergency Contacts Please provide the name and phone numbers of persons to contact in the event of an emergency. A guardian’s name and number must be listed. This also gives consent for the information to be shared with the listed persons. 1. Name: _________________________________
Relationship: _________________________
Phone: (H) ___________________________
(C) _________________________________
2. Name: __________________________________Relationship: _________________________ Phone: (H) ____________________________
(C) _________________________________
INSURANCE INFORMATION: please provide a photo copy of your insurance card. Our athletic training staff will need a copy of your insurance card, both front and back, to keep on file while you participate in our Gannon Women’s Lacrosse clinic!
CLINIC APPLICATION
GENERAL INFORMATION
CLINIC DIRECTOR
Mission Statement:
Kerry O’Donnell Head Coach – Gannon University
Gannon University has established a reputation for excellence both on and off the lacrosse field. The GU Women’s Lacrosse staff and players will provide young female athletes with the same instruction and approach that has helped our own players achieve success. This is your chance to become a part of the Gannon University tradition. Sign up today!
STAFF
Staff will include current players from the Gannon University Women’s Lacrosse Team.
AGES
Girls in grades 9 through 12 are invited on Saturday September 30 from 11am to 1pm.
Participants Name: _________________________________________ Age:____ Grade: ______Yrs experience: ______ Address: ________________________________ City: _____________ State: _______ Zip: ______ Grade: ___ Position: ______ Club Team:_______ School: _______________________________
Our primary purpose of the clinic is to teach Parent’s Name__________________________ COST fundamental skills while developing stick skills and strong game awareness. With these goals in mind, we $50 dollars to register! Cash or check made payable to Email address:__________________________ strive to develop the athlete’s ideas in sportsmanship, Gannon Women’s Lacrosse leadership, and citizenship. Emergency Contact (with Phone number): RULES AND REGULATIONS _______________________________________ Our goal of the clinic is to teach and reinforce skills in a Each athlete will be expected to comply with rules for fun but structured setting. The camp will be gratifying the camp and must follow instructions given by the SIGNATURE OF PARENT OR GUARDIAN clinic director and instructors. Any violation or abuse of _______________________________________ and worthwhile experience for every participant. clinic rules will result in immediate dismissal from the camp without a refund. ARRIVAL & DEPARTURE OF PLAYERS Does your child have any special medical needs we should be aware of? YES / NO Athletes should report to Gannon University Recreation and Wellness Center at least 15 minutes If so, please explain: _________________________________________ prior to start for on-site check in! Athletes will be dismissed on time and should be picked up at the Rec SPECIAL INSTRUCTIONS Center. Parking is available immediately in front of the An athlete who has specific medical instructions should building.
Items Needed for Clinic:
Stick Goggles Mouth guard Sneakers Water
provide a note from parent or guardian. Please send this information in with application.
INSURANCE INFORMATION: please provide a photo copy of your insurance card. Our athletic training staff will need a copy of your insurance card, both front and back, to keep on file while you participate in our clinic!
Waiver of Release of Liability and Assumption of Risk Agreement This document pertains to the athletic event on the premises of Gannon University or any athletically related field where an event may occur in conjunction with the Gannon University Athletic Department. I acknowledge and fully understand that ________________________________ will be engaging in activities that involved risk of serious injury and that may cause severe social and economic losses which may result not only from their own actions, inactions or negligence of others, the rules of play, or the condition of the premises or of any equipment used. Further, that there may be other risks not known or not reasonably foreseeable at this time. My signature releases, waives, discharges and absolves Gannon University from any responsibility pertaining to the aforementioned. My signature also provides consent for my child to receive medical care by the event’s Certified Athletic Trainer and for emergency medical decisions to be made in my child’ best interest. I have read the above waiver, release and understand it. I also understand that I have signed this document voluntarily, intelligently and with full knowledge of its legal consequences as the guardian for ________________________________________________.
___________________________________ ______________________________ Guardian Name (Please Print) Guardian Signature
_____________ Date
Emergency Contacts Please provide the name and phone numbers of persons to contact in the event of an emergency. A guardian’s name and number must be listed. This also gives consent for the information to be shared with the listed persons. 1. Name: _________________________________
Relationship: _________________________
Phone: (H) ___________________________
(C) _________________________________
2. Name: __________________________________Relationship: _________________________ Phone: (H) ____________________________
(C) _________________________________
INSURANCE INFORMATION: please provide a photo copy of your insurance card. Our athletic training staff will need a copy of your insurance card, both front and back, to keep on file while you participate in our Gannon Women’s Lacrosse clinic!
