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									                                                                                                                                                                                                                       C.W. POST

                                                                                                                                                                                                                                              w w w . l i u . e d u / c w p o s t / s u m m e r c a m p s
    PLEASE ENROLL MY CHILD IN THE FOLLOWING                                                                                                                TRANSPORTATION
           (Check all sessions your child will be attending)
                                                                                                                                                             Parents must provide transportation to and from the       PIONEER
                                                                                                                                                           camp. Drop-off and pick-up instructions will be mailed to
SPORTS CAMP PROGRAM           DATES                                                                                                                        you with your confirmation.                                 SPORTS
                                                                                                                                                                Drop-off is between 8:30-9:00 a.m.
______ Boys Baseball
______ Boys Lacrosse
                              June 28-July 2
                              June 28-July 2                                                                                                                    Pick-up is at 3:30 p.m.                                ACADEMY
______ Girls Lacrosse         July 5-July 9                                               OUR STAFF                                                          C.W. Post is located on Route 25A (Northern Blvd.)
______ Girls Softball         July 12-July 16                                               All camps will be led by the                                   between Route 107 and Glen Cove Road in Brookville.
______ Football               July 19-July 23                                             C.W. Post Pioneers’ award-                                       Signs on Campus will direct you to the camp drop-off
______ Field Hockey           July 26-July 30                                             winning coaches and their                                        location.
______ Girls Basketball       July 26-July 30                                             assistants. Each camp group will
______ Boys Basketball        August 2-August 6                                           be supervised at all times by at
______ Each 1-week sports camp ($450)                                                     least two counselors, making
                                                                                          our counselor-to-camper ratio
                              Total ________                                              1-to-7. Since we are committed to Coach John Jez
              Sibling Discount 15% ________                                               providing the most positive experience possible, only the
    Team Discount (5 or more) 10% ________                                                most caring, patient and responsible candidates are
                                                                                          selected as counselors and program staff to care for our
 C.W. Post Employee Discount 25% ________
                                                                                          campers. Our general counselors are over 18 and our
                          Subtotal ________                                               coaches and athletics staff are over 21 years of age. Our
    After Camp ($75 per week) Total ________                                              staff is dedicated to teaching skills through motivating
                            Deposit ________                                              fun-filled activities, drills and positive reinforcements. Our
                           Balance ________
                                                                                          counselors and coaching staff are certified in Standard First
                                                                                          Aid and CPR. Before the campers arrive, all staff members
For applicants using credit cards only:
                                                                                          participate in an intensive training week of safety,
Please charge my credit card in the amount of $ __________                                counseling, teaching and camp policies and procedures.
I am charging this fee to: MasterCard      VISA   Discover
My credit card number is: ____________________________
Exp. Date (Month/Year) ______________________________                                       Tuition is refundable until June 8, 2010, less the non-
Name of Cardholder (please print) ______________________                                  refundable deposit of $200. There will be no exceptions.
CWC# (located on back of card, 3 digit #) ________________                                All withdrawals must be submitted in writing to the C.W.
Signature of Cardholder______________________________
                                                                                          Post Youth Camps’ Office no later than June 8, 2010.
                                                                                          There will be no refunds for days missed. If a camper is
Photo Release – In the event that photographs are taken during the course of              absent for 5 consecutive days due to illness, a credit only
this program, I hereby grant permission to C.W. Post to use the photographs for
promotional purposes. Furthermore, in the event that I am asked to comment                will be given with a doctor’s note. C.W. Post Pioneer
on the program, I hereby grant permission to C.W. Post to use my quote for                Sports Academy reserves the right to dismiss a camper
promotional purposes.

General Release – I understand and certify that my child’s participation in the
                                                                                          whose conduct or influence is unsatisfactory or, in the
                                                                                          opinion of the director, not in the best interest of the
                                                                                                                                                                                                                       BOYS LACROSSE
C.W. Post Summer Day Camp/Pioneer Sports Academy and its activities is
completely voluntary, and I have familiarized myself with the camp’s programs
and activities in which my child will be participating. I recognize that certain
                                                                                          camp. In the event of such a dismissal, no refund or credit
                                                                                          will be made. Possession of tobacco, alcohol, illegal drugs
hazards are inherent in the C.W. Post Summer Day Camp/Pioneer Sports Academy
activities, and I acknowledge that, although C.W. Post Summer Day Camp/Pioneer
Sports Academy has taken safety measures to minimize the risk of injury to camp
                                                                                          or weapons is grounds for immediate dismissal from
                                                                                          camp. If camp closes due to a natural disaster such as a
                                                                                                                                                                                                                       June 28-July 2, 2010
participants, C.W. Post cannot insure or guarantee that the participants, equip-
ment, premises and/or activities will be free of hazards, accidents and/or injuries.      blackout, hurricane, etc., there will be no refund issued for                               PIONEER
   I recognize and have instructed my child in the importance of knowing and abiding by   that day or days.
the camp’s rules and procedures for the safety of the camp participants.                                                                                                               SPORTS
   I hereby release C.W. Post, its employees and agents, from any damages or                A $200 deposit must accompany the registration form                                       ACADEMY
injury including death caused by, derived from, or associated with my child’s             and will be deducted from the tuition. THE BALANCE MUST
participation in the camp, except for such damages or injury or death as may be
caused by gross negligence or willful misconduct of the employees or agents of            BE PAID IN FULL BEFORE JUNE 8, 2010. CAMPERS MUST                                             2010
C.W. Post.                                                                                BE REGISTERED IN ADVANCE. SINCE CAMP SIZE IS
   I agree to cover all medical bills not covered by my insurance.
                                                                                          LIMITED, EARLY REGISTRATION IS ENCOURAGED. CAMP
X                                                              X                          FILLS UP QUICKLY.
               Parent/Guardian Signature                               Date
                                                                  INSTRUCTIONAL FOCUS
       BOYS                                                       IMPROVE SKILLS IN: • Shooting • Dodging • Passing
                                                                  • Face-offs • Footwork • Take-away Checks • Positioning
     LACROSSE                                                     • Goalie play
                                                                  Also work on sport specific conditioning through proven
       CAMP                                                       drills and exercises!                                                                                                                               REGISTRATION FORM
    HEAD COACH • JOHN JEZ                                                                                                                                                                                         Please return this application and a check for the $200
                                                                  TYPICAL DAILY SCHEDULE
Camp Dates: June 28-July 2, 2010                                  (times & events may vary)                                                                                                                       deposit (made payable to Long Island University) or
    For campers ages 7 - 17                                                                                                                                                                                       your completed credit card information to: C.W. Post Youth
                                                                  8:30-9 a.m.     Drop-Off
                                                                                                                                                                                                                  Camps, Pioneer Sports Academy, C.W. Post Campus, Long
                                                                  9-9:30 a.m.     Stretching and Warm-Up
                                         The PIONEER SPORTS       9:30-11 a.m.    Instructional Stations                                                                                                          Island University, 720 Northern Blvd., Brookville, New York
                                       ACADEMY BOYS               11 a.m.-12 p.m. Skills Competitions                                                                                                             11548-1300. This form may be photocopied if more than
                                       LACROSSE CAMP is                                                                                     PRATT RECREATION CENTER                                               one child will be attending. If paying by credit card, you
                                                                  12-1 p.m.       Lunch (provided daily)
                                       dedicated to providing     1-2 p.m.        Swim                                                        Campers will have access to the Pratt Recreation Center,            may fax your registration to: (516) 299-3435.
                                       concentrated instruction   2-3:15 p.m.     Competitions & Games                                      a 77,000-square-foot state-of-the-art facility featuring an
                                       that is essential to the   3:15-3:30 p.m. Snack                                                      8-lane swimming pool; a gymnasium with three full-size                Child’s Name__________________________________
                                       development of the         3:30 p.m.       Pick-Up                                                   courts for basketball and volleyball; an elevated Mondo-X                Male       Female Age (as of 6/8/10): __________
                                       young lacrosse player,                                                                               indoor jogging track; fitness and weight training room; a
                                                                  After-Camp Program available until 6 p.m. for additional fee.                                                                                   Birthdate __________
                                       whether at the beginner                                                                              multipurpose room for aerobics; and two racquetball courts.
                                       or advanced level.                                                                                                                                                         Has your child previously attended the Day Camp at
                                       Players are grouped        WHAT TO BRING TO CAMP                                                                                                                           C.W. Post?     Yes How many years? _______ No
                                       according to age, skill                                                                              C.W. POST CAMPUS
                                                                  K Lacrosse Stick K Helmet K Shoulder Pads                                    The C.W. Post Campus of Long Island University is located on       Child lives with: (Indicate all that apply)
                                       level and experience.      K Arm Pads K Mouthpiece K Athletic Supporter                              307 beautiful acres in Brookville, New York, on the north shore         Father        Mother         Step-Parent
                                       Each player will receive   K Extra Socks K Turf/Cleats/Sneakers (rain days)                          of Long Island. The campus is set in the idyllic neighborhood           Other (Fill-in) _____________________________
                                       specialized training to    K Sunscreen (recommended) K Bathing Suit/Towel
                                       sharpen his own ability.                                                                             known as the “Gold Cost,” an historic suburban community              My child may be released to the following person/persons:
                                                                  K Water Bottle*                                                           that has been the subject of popular novels and major motion
                                       For the college-bound                                                                                                                                                      Parent(s) or Guardian(s) __________________________
                                                                  PLEASE LABEL ALL ITEMS CLEARLY WITH FIRST AND LAST NAMES.                 pictures. The campus is just 50 minutes away from the
                                       athlete, the Pioneer       The Pioneer Sports Academy is not responsible for lost or stolen items.
Sports Academy Boys Lacrosse Camp provides a great                                                                                          excitement of New York City.                                          Permanent Address ____________________________
                                                                  *water breaks will be implemented during all instructional/game times
arena for college coaches to get a good look at the                                                                                                                                                               City ________________________________________
advanced player. From start to finish, campers are
                                                                                                                                                                                                                  State ______________________________________
exposed to a high level of instruction and introduced to                                                                                      The C.W. Post Youth Camps and Pioneer Sports Academy
motivational skills that will assist beginners and experienced                                                                                are licensed by and given a permit by the New York State            ZIP Code ____________________________________
players alike.                                                                                                                                Department of Health. The Camps are inspected twice yearly.         Home Phone (        ) ____________________________
  The camp is under the direction of C.W. Post Men’s                                                                                          Persons may obtain a copy of the camp’s records at the
Lacrosse Head Coach, John Jez. As the 2009 Division II                                                                                        Nassau County Department of Health Office of Recreational           Cell Phone (mother) (    ) ________________________
Coach of the Year, Jez guided the Pioneer squad to the                                                                                        Facilities Children’s Camps, 106 Charles Lindberg Blvd.,            Cell Phone (father) (   ) ________________________
best record in the program’s 50 year history (15-1) and a                                                                                     Uniondale, NY 11553. Inquiries can be made Monday-Friday
2009 National Championship title. He is the founder of                                                                                        9 a.m.-4:45 p.m. at (516) 227-9717 or fax (516) 227-9613.           E-mail address ________________________________
Precision Lacrosse Camps and has been coaching for                                                                                                                                                                T-shirt Size (Circle one):
more than 15 years. Jez has been the assistant general                                                                                                           C.W. Post Pioneer Sports Academy is accredited   Child: XS S M L XL            or    Adult: S M L XL
                                                                                                                                                                 by the American Camping Association.
manager for the U.S. Men’s National Lacrosse Team
                                                                                                                                                                                                                  How did you hear about C.W. Post Pioneer Sports
since 2006.


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