PERFECT CONNECTIONS LACROSSE CAMP by ert554898

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									  AMATEUR ATHLETIC MINOR WAIVER                                                                             PERFECT




                                                                          Moorestown, NJ 08057
                                                                          908 Mansfield Drive
                                                                          Deanna Knobloch
     AND RELEASE OF LIABILITY
                                                                                                          CONNECTIONS
          ***MUST BE FILLED OUT***
THE UNDERSIGNED:
1. Agree that the parent(s) or legal guardians(s) will instruct the
minor participant that she should inspect the facilities and equipment
to be used, and if she believes anything to be unsafe, she should
report it immediately to the supervisor or refuse to participate.

2. Acknowledge and fully understand that each participant will be
engaging in activities that involve risk of serious injury, including
permanent disability and death, and severe social and economic
losses which might result not only from their own actions, inaction or
negligence but the action, inaction 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 to us or not reasona-
bly foreseen at this time.

3. Assume all the foregoing risk and accept personal responsibility
for the damages following such injury, permanent disability and
                                                                                                      LACROSSE CAMP
death.

4. Release, waive, discharge, and covenant not sue South Jersey
Select Lacrosse, its administrators, coaches and other employees of
the organization, other participants, sponsoring agencies from any
                                                                                                 ****************************
and all liability to each of the undersigned, her heirs and the next of                                   Directed by:
kin for any and all claims, demands, losses, or damages on account of
injury, including death or damage to property to be caused in whole                                     Deanna Knobloch
or in part by the negligence of the releasees, or otherwise.
                                                                                                      Head lacrosse Coach
I/WE HAVE READ THE ABOVE WAIVER AND RELEASE,                                                         Moorestown High School
UNDERSTAND THAT I/WE GIVE UP SUBSTANTIAL RIGHTS
BY SIGNING IT AND SIGN IT VOLUNTARILY.

                                                                                                 ****************************
______________________________________________________
Signed Parent or Guardian                          Date                                                   June 27th—July 1st
                                                                                                                   At
______________________________________________________
Printed Name of Parent or Guardian
                                                                                                        Moorestown High School
                                                                                                         9:00 a.m. to 12:00p.m
______________________________________________________
Printed Name of Participant
                                                                                                               FOR GIRLS ENTERING
______________________________________________________                                                             GRADES 4-12
Primary Insurance Company

                                                                                                   The Moorestown Township Board of Education does not necessarily
______________________________________________________
                                                                                                 sponsor or endorse the contents of this notice or the organization respon-
Policy Number
                                                                                                                    sible for disseminating this notice.
          ABOUT THE CAMP:                                          ABOUT THE COACHES:                                                   APPLICATION
Perfect Connections Lacrosse Camp is designed to push                         THE DIRECTOR:                               Name_______________________________________
you at your pace and level. Our outstanding coaches are
committed to sharing their knowledge of the game and          DEANNA KNOBLOCH                                             Address______________________________________
their passion for the sport of lacrosse. Our goal is to en-   • Head Coach – Moorestown High School – 1992 –
able you to have fun while providing the safest learning         present RECORD: 377-23-4                                 City___________________State_____Zip__________
environment to help you be the best lacrosse player you       • State Champions – ‘95, ‘00, ‘01, ‘02,
can be!                                                          ‘03,’04,’05.’06, ‘07, ‘08, ‘09                           Telephone____________________________________
______________________________________________                • Ranked #1 in the Nation by Lacrosse Magazine –
      ***HIGH SCHOOL LEVEL***                                    ‘01, ‘02                                                 Parent’s Names________________________________
                                                                                                                                   Work Phone___________________________
     GIRSL ENTERING GRADES 9-12                               • Philadelphia Inquirer Coach of the Year – 2002
                                                                                                                                   Cell Phone____________________________
                                                              • Inducted into NJ Lacrosse Hall of Fame – 2004
This level is designed to focus exclusively on perfecting     • Trenton State College Lacrosse All-American               E-mail address_________________________________
fundamentals and team play. Shooting, offensive and
defensive strategies, team offense, team defense and mid-
field play will also be stressed.
                                                                     *      *       *      *       *      *               Emergency Contact:
                                                                                                                                 Name________________________________
     For advanced HS players—please check out our                                 THE STAFF:
                                                                                                                                 Tel. #_________________________________
           Moorestown Select Lacrosse Camp at
                    www.sjselectlax.com                       COURTNEY LEGATH
                                                                                                                          School attending:_______________________________
                                                              • JV Coach—Moorestown High School
                                                              • Boston College Lacrosse Alumni
     ***MIDDLE SCHOOL LEVEL***                                SARA SHELLEY
                                                                                                                          Birth Date________________
                                                                                                                          Grade in September 2011_________
      GIRLS ENTERING GRADES 4-8                               • Head Coach—Rancocas Valley High School
                                                              • University of Penn Lacrosse/Field Hockey Alumni           Level Played: Please circle or elaborate
This level is designed to develop basic skills and strate-    BETH SERUGHETTI                                                      Beginner________________________
gies. Individual attack and defensive techniques will also    • Head Coach—WW-P North High School                                  Middle School____________________
be emphasized. Mini games and fun drills will be incor-       • Trenton State College Lacrosse Alumni                              Freshman________________________
porated every day!!                                           KARRIE DOUGLAS                                                       JV______________________________
                                                              • Moorestown 8th grade coach                                         Varsity__________________________
 SPECIALIZED GOALIE INSTRUCTION                               • Rowan University Lacrosse Alumni
     ***WILL BE PROVIDED***                                                                                               Position:_________________________________

 LITTLE PERFECT CONNECTIONS LAX CAMP                                  **PLUS COLLEGIATE PLAYERS**                                             COST—$175
          For girls entering grades 1-3                                                                                   Make checks payable to:
      Please download additional form from                                  COST: $175 Per Player                                  SOUTH JERSEY SELECT LACROSSE
              www.sjselectlax.com                                          TIME: 9:00am – 12:00 pm                        Send to:
                                                                 LOCATION: Behind Moorestown High School                           Perfect Connections Lacrosse Camp
                                                              (Please check www.sjselectlax.com for any changes)                         C/O Deanna Knobloch
              CAMP HIGHLIGHTS                                                                                                              908 Mansfield Drive
                                                                                                                                         Moorestown, NJ 08057
 •    REVERSIBLE MESH TANK TOP
                                                              EQUIPMENT: All campers must have their own stick,                   Questions? Email Deanna Knobloch at
 •    MOST ACCURATE SHOT CONTEST                                                                                                           mhslax01@aol.com
 •    7 V 7 TOURNAMENT                                        mouthguard, goggles, water cooler and proper footwear   .
 •    DAILY LACROSSE GIVE-AWAYS                                                                                               Campers will not be notified of their acceptance
                                                               All equipment can be purchased at HER SPORT in
 •    CAMP STORE                                                               Haddonfield NJ.
                                                                                                                             into the camp. Please just plan to show up at 8:30
 •    GUARANTEED FUN FOR ALL!!                                                                                                          on the 27th for registration!
                                                                                                                              (check www.sjselectlax.com for camp changes)

								
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