Pentathlon

Youth and Juniors Open Training Camp and National qualifier

Rancho Mirage, CA

June 21,2012-June 24 2012

Entry Form

Name ______M__ F__ Birth date ______Age _____

Address ______

Home phone ______Cell phone______E- mail______

Mother’s name ______Cell phone______Work phone______

Father’s name ______Cell phone______Work phone______

Emergency contact ______Cell phone______Work phone______

Medical insurance carrier ______Policy # ______

Policyholder ______Medication(s) ______

Allergies ______Dietary restrictions ______

Waiver of Liability

I hereby release and discharge West Coast Pentathlon, its agents, volunteers and officers, from all claims, demands, actions, judgments and executions which the undersigned’s' heirs, executors, administrators, or assigns may have against West Coast Pentathlon, its successors or assigns, for all personal injuries known or unknown, and injuries to property, real or personal, caused by or arising out of pentathlon training sessions.

Name (Print)______Signature______

For minors:

Parent or Guardian (Print) ______Relation______

Signature ______Date ______

Please also sign and send the attached waiver for Equestrian Centers International, as well as West Coast Pentathlon liability and medical releases.

Fees and contact information

Camp fee of $360 includes all instruction plus lunch and transportation for four days. There is an additional mandatory groom tip of $20. Please enclose a check or money order for $360 to hold your place for the campers. Deadline is June 15, 2012.

Please send entry form and a check or money order payable to West Coast Pentathlon for $360. to:

West Coast Pentathlon

171 H Lane, Novato CA 94745

For more information, contact Pat Duffy, President of West Coast Pentathlon, at 415-892-4242 or email her at .

Check for an updated camp schedule.

Camper information

Arrival/Departure

Campers may arrive any time on June 21.Let us know your flight and arrival information, and we will pick you up at the Palm Springs International Airport.

Arrival date ______Time ______Flight #______Airline ______

Departure date ______Time ______Flight #______Airline ______

Stats

Best tet/pentathlon event ______Date ______Overall score ______

Height ______Weight_____ 200-meter swim time ______3K run time ______

Rating (Pony Club) ______Division (Pentathlon) ______

Years riding ______Comfortable jump height ______

Years fenced ______Rating ______Do you own fencing equipment? ______

Years shooting ______Best shoot score ______Pistol model/Serial # ______

Coaches

We have the best!

  • Swimming—: TBA
  • Shooting--Januza Peciak:Olympic Gold Medalist and Olympic Coach, Carmelo Felix- Olympian,
  • Riding--Michael Cintas: Modern Pentathlon Olympic riding coach and owner of Equestrian Centers International at Rancho Mirage
  • Running, Fencing—Carmelo Felix: Modern Pentathlon World Cup medalist and member of the Mexican Olympic team in Barcelona
  • Fencing-Janusz and Carmelo

Camp schedule

June 21: Arrival day! Depending upon your arrival time, you will be able to fence, run, shoot, and ride. Or, you can just get settled in and enjoy life in the desert. We will be staying at theHoliday Inn Express Rancho Mirage.

June 21-23: We will divide the campers into small rotating groups so all can enjoy individualized attention from the coaches. Campers will have the opportunity to participate in all five sports on most days. Once you are enrolled, we will email you updates as they occur.

June 24 - Competition

Details

  • Bring running, swimming, fencing, and riding attire. Please bring your own equipment (epées, fencing clothing, pistols, riding helmets, etc.). A checklist and other information will be posted on the westcoastpentathlon.com website soon.
  • lodging will be chaperoned, ground transportation provided. However, please send pocket money in case your child wants to shop, eat out or go to the movies.
  • Campers must be at least 12 old.

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