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GIRLS LACROSSE CAMP MONDAY THROUGH FRIDAY June 27–July 1, 2011 Day Camp Colchester, Vermont 05439 Permit No. 154 One Winooski Park, Box 258 05401 Athletic Department Burlington, VT PAID U.S. POSTAGE Organization Non-Proﬁt SAINT MICHAEL’S COLLEGE GIRLS LACROSSE CAMP HEALTH FORM In case of emegency contact: ____________________________________________________ Phone: ____________________________ I understand our family will provide insurance coverage if our son/daughter is injured while participating in a Saint Michael’s College Sports Camp. Health Insurance: Company: ___________________________________________________ Policy #: ____________________________________________________ Family Doctor: ________________________________________________ I hereby state that my son/daughter is in good health and may participate in the Saint Michael’s College All Sports Camp. I also give permission to the attending health professional, in case of emergency, to allow my son/daughter to be treated in the hospital emergency room, if necessary. Printed name of Parent/Guardian _________________________________________ Signature of Parent/Guardian _________________________________________ Please list any special health problems or special circumstances: _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ Return to: Saint Michael’s College Summer Camps, Athletic Department, One Winooski Park, Box 258, Colchester, Vermont 05439 GENERAL INFORMATION CAMP INFORMATION SAINT MICHAEL’S COLLEGE GIRLS LACROSSE CAMP APPLICATION Adult: S M L CAMP DIRECTOR OBJECTIVE Ashley Hughes, Saint Michael’s College Women’s Lacrosse Head Coach; Former To create a positive and encouraging environment that will enable players to learn Assistant Women’s Lacrosse and Soccer Coach at Norwich University, and Assis- about the exciting and challenging game of lacrosse. Training sessions will focus on Zip: Any registration received/postmarked after the deadline date will need to add an additional $25.00. This will also apply to any walk-ins the day of camp registration. tant Lacrosse Coach at Hartwick College. Ashley Hughes is a former lacrosse and individual skill development and will provide athletes with a variety of team tactics. Age (at time of camp): soccer athlete at Allegheny College in Meadville, Pennsylvania and graduated as Campers will be assigned to a level based on age and experience. Allegheny’s all time leading points scorer, goal scorer and also holds the records for assists. Hughes was a three time all conference lacrosse member and a two time all FEES The balance of camp fees paid upon registration. Please complete statement of health form on other side. $25/camp is non-refundable. Date of Birth: regional member. Coach Hughes also coaches the U-17 Premier team for Far Post • Day Camp: $235.00 per week (5 full days and includes lunch). Child: L Soccer Club. • Make checks payable to Saint Michael’s College. State: • Fee includes meal, camp t-shirt and awards. COACHING STAFF Our staff will include Saint Michael’s College coaches and high school coaches. DEPOSIT/CANCELLATION/ REFUNDS Current Saint Michael’s College players will also serve as instructors. A $100 deposit per camp is required and should accompany your application. $25 Parent’s day/work phone: of the total deposit is non-refundable. The balance is refundable up to one month T-Shirt Size (circle one): EQUIPMENT prior to the start of camp. No refunds will be given to campers who voluntarily Initials: Saint Michael’s College Summer Camps, Athletic Department, One Winooski Park, Box 258, Colchester, VT 05439 All campers will provide their own shorts, shirts, swimsuit, towel, combination leave camp or who are sent home for disciplinary reasons. lock, water bottle, and sneakers/cleats. All campers must have two pairs of shoes— Your canceled check confirms your enrollment in the camp that you chose. one pair to be worn for inside activities, and the other to be worn outside. Outdoor footwear and/or black-soled sneakers will not be permitted on indoor courts. Please note: incomplete applications will be returned and processing delayed. City: In addition, each camper must provide their own eye guards lacrosse stick and a Any registration received/postmarked after the deadline date will need to add an mouthguard. Goalkeepers must provide their own equipment. additional $25.00. This will also apply to any walk-ins the day of camp registration. Amount Due: A deposit of $100 is required for EACH WEEK OF CAMP your child will be attending. FORMS REGISTRATION • Complete the attached registration form. Incomplete forms will be returned. Tarrant Recreation Center at 8:30 a.m., first day of camp. • Complete the Statement of Health form on reverse side. (Application due June 13, 2011) DATES & TIMES MEDICAL/INSURANCE Monday, June 27 to Friday, July 1, 2011, 9:00 a.m.–3:30 p.m. An athletic trainer is on duty while camp is in session. Coverage by family or other health and accident insurance is required. FOR FURTHER INFORMATION, PLEASE CONTACT: Check #: Please make checks payable to Saint Michael’s College and return to: Ashley Hughes, Camp Director MEALS Athletic Department, Saint Michael’s College Lunch will be provided for our full-day campers in our campus dining One Winooski Park, Box 258, Colchester, Vermont 05439 facility and is included with the camp fee. 802.654.2634 • firstname.lastname@example.org www.smcvt.edu/athleticcamps FULL-DAY CAMPS School: Amount Pd: • Offered for girls entering grades 5-10. Please indicate the session desired for camp: ____ Day camp ($235) / June 27–July 1, 2011 • Monday through Friday, 9:00 a.m. to 3:30 p.m. • Opportunity to use swimming pool. Signature of parent/guardian: Name of parent/guardian: Office Only: Date Rec’d: E-mail for confirmation: Grade entering in fall: Home phone: Address: Name:
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