Championship Throws Camp - 2008

Spearfish SD at the Black Hills State University Track and Field Facility - JULY 28 - 30  2008 - Shot Put & Discus

 APPLICATION FORM 

NAME________________________________________________________

ADDRESS_____________________________________________________

CITY_________________________________________________________

STATE_______________________________________________________

ZIP__________________________________________________

HOME PHONE_________________________________________

WORK PHONE_________________________________________

E-MAIL_______________________________________________ 

BEST DISTANCES IN A MEET –  SHOT PUT  ______    DISCUS   _______  HAMMER__________ JAVELIN__________

Age _______________  Grade(2008- 09 School Year)______________  Sex___________ 

T-Shirt Size: Small______ Medium_______ Large_______ X-Large________ XX-Large_______ XXX-Large_______

MEDICAL RELEASE

MEDICAL INSURANCE COMPANY .__________________________________________________________________________________

SUBSCRIBERS NAME__________________________________________________________________

POLICY/GROUP /ID#___________________________________________________________________

DOCTOR’S NAME & PHONE #

______________________________________________________________________________________

ALLERGIES, MEDICATIONS, CONDITIONS, LIMITATIONS:

_____________________________________________________________________________________
WAIVER:

I HEREBY AUTHORIZE MY CHILD’S PARTICIPATION IN THE CHAMPIONSHIP THROWS CAMP. I KNOW OF NO PHYSICAL, MENTAL, EMOTIONAL OR BEHAVIORAL PROBLEM WHICH MAY AFFECT MY CHILD’S ABILITY TO SAFELY PARTICIPATE. THE CAMP STAFF IS AUTHORIZED TO ATTEND TO ANY HEALTH PROBLEM OR INJURY MY CHILD MAY INCUR WHILE ATTENDING CAMP.

I UNDERSTAND THAT MY CHILD MUST HAVE CURRENT AND ACTIVE MEDICAL INSURANCE BEFORE HE/SHE MAY ATTEND CAMP AND HEREBY CONFIRM THAT HE/SHE DOES. NEITHER MY CHILD NOR I WILL HOLD THE CHAMPIONSHIP THROWS CAMP OR THEIR EMPLOYEES RESPONSIBLE FOR ANY INJURIES/ILLNESSES/ OR EXPENSES THAT MAY OCCUR DURING THIS CAMP.

____________________________________________________

DATE  - SIGNATURE OF PARENT OR GUARDIAN 

CAMP COST - $125 + tax 

(INCLUDES INSTRUCTION AND CAMP T SHIRT)

BRING YOUR OWN IMPLEMENTS TO CAMP - THE CTC WILL NOT BE FURNISHING IMPLEMENTS.  WE RECOMMEND 1 SHOT PUT AND 2 DISCS

 APPLICATION DEADLINE: JULY 1ST

           Print this form and mail it along with your $50 non-refundable deposit to: Terry Long - 1104 Needles Drive - Custer, SD 57730

 or for more information call: 605-441-6241 or 605-441-8991

or E-MAIL: rash_10@hotmail.com or tlong@csd.k12.sd.us

'CTC'

 

 'CCTC'

CIRCLE OF CHAMPIONS THROWS CAMP APPLICATION FORM

A Developmental Shot Put and Discus Camp for Boys and Girls Grades

7—12 of All Skill Levels.

 June 18-20 at Howard Wood Field in Sioux Falls, South Dakota

 Applications are due by JUNE 1, 2008!

NAME__________________________

ADDRESS______________________

CITY___________________________

STATE__________   ZIP__________

 PHONE________________________

 CELL__________________________

EMAIL_________________________

 AGE__________  GRADE 08-09_____

 BEST MARKS IN A MEET

 SHOT__________   DISCUS________

 SHIRT SIZE  S_____ M_____  L_____  XL_____   2X        _____    3X_____

Medical Release:

Medical Insurance Company__________________________

Subscribers Name____________________________________________________

Policy / Group / ID#____________________________________________________

Doctor’s Name & Phone #____________________________________________________

Allergies, Medications, Conditions, Limitations:

________________________________________________________________________________________________________

WAIVER:

I hereby authorize my child’s participation in the Circle of Champions throws Camp. I know of no physical, mental, emotional, or behavioral problem which may affect my child’s ability to safely participate. The camp staff is authorized to attend to any health problem or injury my child may incur while attending camp.

I understand that my child must have current and active medical insurance before he/she may    attend camp and hereby confirm that he/she does. Neither my child nor I will hold the Circle of Champions Camp or Howard Wood Field       employees responsible for any injuries, illnesses, or expenses that may occur during this camp

_______________________________________ DATE—SIGNATURE OF PARENT / GUARDIAN

CCTC AT SIOUX FALLS - $185

*Copy/print this form, complete it and mail with $100 non-refundable deposit to:

Tom Rice - PO Box 3, Gayville, SD 57031

For more information call: 605-267-0437 OR 605-323-7346  Or E-Mail tom.rice@k1

 

'CTC' CHAMPIONSHIP THROWS CAMP

 'CCTC' CIRCLE OF CHAMPIONS THROWS CAMP