Future College Athlete Field Hockey College Camp
Email address
Campers First Name
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Campers Last Name
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Campers High School
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Graduation Year in High School
What Camp T-shirt size do you want?
You must register prior to Dec 1, 2017 to guarantee shirt size (Adult sizes)
Camper's date of birth
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Camper's GPA
cumulative
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Camper's SAT or ACT score
or date taking
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Please list Camper's Primary Position
Primary position
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Please list Camper's Secondary Position
Secondary position
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Camper's email
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Camper's Phone Number
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Parent/Guardian First Name
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Parent/Guardian Last name
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Parent/Guardian Email
This email will be used to send the medical release form to
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Parent/Guardian Phone Number
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Parent/Guardian Address
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Emergency Contact
Name
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Emergency Contact
Relationship to camper
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Emergency Contact
phone number
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Medical Information
Who is your insurance provider?
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Medical Information
Policy number
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Medical Information
Doctors Name
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Medical Information
Doctors contact information
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Medical Information
Does your child have any drug allergies? if Yes specify
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Medical Information
Does your child have any food allergies? if Yes specify
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Medical Information
Does your child take any medication? if Yes specify
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Please make checks out to Future College Athlete and mail Check to:
Riki-Ann Serrins Attn: Future College Athlete 11693 San Vicente Blvd. #468, Los Angeles CA 90049
Required
Camp fee is $395
Cancellation/Refund Policy
REFUND POLICY: Fees are only fully refundable if 1) registration is already full at time registration was received 2) camp is canceled, or 3) camper withdraws and a waitlisted camper takes their place. No refunds whatsoever will be made for other circumstances. Both the Registration and Emergency/Medical Forms must be completed for each camper attending Future College Athlete Field Hockey College Coaches Camp before registration is processed. If the registration material is not fully completed, the material will be returned for completion. This will most likely delay enrollment in the camp and could result in the student-athlete being wait-listed.
Required
Assumption of Risk and Release from Liability
I am the parent or legal guardian of the above mentioned Student Athlete, and I request that my student athlete participate in Future College Athlete Field Hockey College Coaches Camp. As consideration for Future College Athlete allowing my child to participate in the camp, I agree to the terms and conditions of this Agreement. I am not aware of any medical or other reason why my child should not participate in the camp. I acknowledge that this form directs me to advise a Future College Athlete representative immediately if I believe any aspect of the camp’s facilities or equipment to be unsafe, and not to permit my child to participate in the camp if I believe it to be unsafe. I assume all risks arising out of, or relating to, my child’s participation in the camp. I acknowledge that the risks to my child include but are not limited to personal injury (including emotional/psychological harm), serious bodily harm, permanent and temporary disability, and death. I acknowledge that these risks are inherent in the camp and cannot be eliminated. To the fullest extent permitted by law, I voluntarily release and covenant not to sue Future College Athlete and each of its trustees, officers, directors, coaches, and other employees and agents (“the released parties”) from any and all claims and liabilities, whether caused by negligence or otherwise, that arise out of or relate to my child’s participation in the camp. I also understand that I am not releasing the released parties from any injury my child may suffer as a direct result of the released parties’ intentional misconduct or gross negligence.
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