Coach Ramshaw’sGymnastics Camp 2016
Open to students in the Olathe School District that will be in grades 9-12 at Olathe South High School in the 2016-2017 school year.This is anon-school sponsored gymnastics camp.
Hosted by:
Kristin Ramshaw, Head Coach,Olathe South Gymnastics Team
Megan Williams, Assistant Coach, Olathe South Gymnastics Team
Special Thanks To: 360 Gymnastics
Please complete and return this form plus$40 payment (cash or check – make payable to Kristin Ramshaw) to Coach Ramshaw on the first day of camp.
Parents, please make sure to sign the release on page 2 of this form.
Camp participant… gymnast information:
First Name: ______Last Name: ______
Date of birth: ______Current age: ______Grade you will be in next year (2016-2017): ______
Student cell phone: ______Student home phone: ______
I would like to receive text messages about upcoming OS gymnastics events: _____ yes _____ no
Student email address: ______
T-Shirt Size: SML XL(shirts will be given out during camp)
Parent information:
Parent name(s):______
Parent daytime phone number(s): Cell or home? ______
Emergency contact and phone number: ______
Health Insurance Company ______Policy/Group # ______Primary Care Doctor ______Primary Care Doctor Phone #: ______
Medical History…optional but helpful… Parents please complete this section…
Are there any physical limitations that would be helpful for the coaches to know about when working with your child? If so, please explain.
Does the participant have any pre-existing medical conditions or injuries that the coaches should know about when working with your child? If so, please explain.
Parent/Guardian… Please read and sign:
Olathe Release:
It is expressly understood that I/we release Olathe Public Schools, employees, and agents, from liability arising from this activity and further I/we will hold harmless and indemnify those entities against claims I/we may have. None of the undersigned or anyone claiming through us will bring, commence, prosecute, or maintain, or cause permit to be brought any suit or action for injury arising out of this activity.
In the event that I, the undersigned, cannot be reached within a period deemed reasonable by medical authorities, I do hereby give consent for any licensed physician to perform any medical procedure of an emergency nature which said physician deems necessary for the health and well-being of my child.
General Release:
I recognize that severe injuries, including permanent paralysis or death, can occur in sports or activities involving height or motion, those activities including but not limited to gymnastics, tumbling, and trampoline. I am also aware that participation in day camps involves transportation to and from field trips and such transportation could cause injury or death in a vehicular accident. Being fully aware of these dangers, I hereby give consent for my child to participate in any and all of Coach Ramshaw’s Gymnastics Camp and activities within the camp and I accept all risks associated with any activities or participation.
In consideration for my child’s participation, I hereby, for myself and my child and our respective heirs and successors promise not to sue and forever releasethe coaches and all personnel associated with the camp, from all liability resulting in damages or injuries incurred as a result of participation including those resulting from acts of negligence.
I am aware that individual and group publicity photos and videos are taken from time to time and in considerations for my or my child’s participation I hereby grant my permission for my child’s likeness to be used in future Olathe South Gymnastics publicity/media.
In the event of an accident or emergency I herby authorize my child to be transported to a hospital for medical treatment and I hold Coach Ramshaw and her representatives harmless in the execution of such. Additionally, I hereby agree to individually provide for all medical expenses which may be incurred by myself or my child as a result of injury sustained while participating at Coach Ramshaw’s Gymnastics Camp.
I give ______permission to participate in Coach Ramshaw’s Gymnastics Camp (July 11-13, 2016).
______
Parent/Guardian SignatureDate
Parent/Guardian Daytime Phone # ______(cell/work/home?)