Granite State Rowing Camp Registration - Summer 2016
Hosted by Bedford Crew
Bedfordcrew.org
Registration - Granite State Rowing Camp Summer 2016
****** WE ARE NO LONGER ACCEPTING APPLICATIONS FOR SUMMER CAMP. FOR MORE INFORMATION, CONTACT LORI AT LASHOOH@COMCAST.NET ************

Welcome to Bedford Crew online registration for our 2016 GRANITE STATE ROWING CAMP.

The Granite State Rowing Camp (hosted by Bedford Crew) is a one-week, co-ed day camp for both new and experienced rowers for current 7th and 8th graders (those who will be entering 8th and 9th grade in the fall of 2016). Campers must be enrolled in the Bedford School District. Rowers will be grouped based on ability, so no experience is necessary. The camp will be run by experienced Bedford High School coaches with assistance by some of the high school rowers.The focus of the coaches is to better the skills of each individual camper through a fun and relaxed environment. Although rowing is the focus of this camp, anyone who likes the outdoors and water based sports will love this program. This camp will provide young adults with a fun and safe environment to work on fitness, teamwork, and friendship. Lots of fun and laughs are guaranteed! It’s a great opportunity to see if rowing is what you might like to do in high school. Or, if you know it’s what you want to do, it’s a great way to get a head start!

When: July 18th – 22nd , 2016
Monday – Thursday, 9:00-3:30
Friday, 9:00-Noon

Where: Amoskeag Rowing Club
101 Merrimack Street
Hooksett, NH

Who: Students starting 8th and 9th grades in fall of 2016 in the Bedford School District
Maximum of 25 rowers

Cost: $375 per rower

To confirm your spot on the camp roster, we must receive the $375 registration fee by June 1st.

Please make checks payable to "Bedford Crew" and mail payment to:

Bedford Crew
Attn: Summer Camp
PO Box 10206
Bedford, NH 03110

❖ Registration will be open on a first-come, first-served basis.
❖ Our capacity for the program is 25 rowers, but we will be accepting waitlist registrations once capacity is reached.
❖ This online registration replaces any paper registration needed.
❖ NOTE: The online registration does not accept online payment.

CANCELLATION FEE:
❖Withdrawal requested prior to June 1st:
100% refund of total registration fees refunded less a $25 administrative fee per rower.

❖Withdrawal requested after June 1st:
No refund.



IMPORTANT ONLINE REGISTRATION INSTRUCTIONS:

1) This program is restricted to participants currently in 7 and 8th grades (entering grades 8 to 9 in fall 2016).

2) We are limiting participation to 25 campers, registration will be open on a first-come, first served basis.

3) We will be accepting wait list registrations once capacity is reached.

4) Cancellation fees will apply should you withdraw your registration. Please note our fee schedule above.

5) For your records please print the registration form.
-This needs to be done after you complete it but BEFORE you select the "submit" button.
-You will be able to print through your browser menu.

Rower Information
Rower's Last Name
Your answer
Rower's First Name
Your answer
Gender
Required
Address (# and Street)
Your answer
Address (City, State, Zip)
Your answer
Home Phone # (xxx-xxx-xxxx)
Your answer
Rower Email
Please make sure email is accurate, since this is our primary way to communicate information.
Your answer
Rower Cell # (xxx-xxx-xxxx)
Your answer
Date of Birth
MM
/
DD
/
YYYY
Grade in fall 2016
Required
Rowing Experience
What is your rowing experience?
Required
If experienced, please describe.
Your answer
Email (Parent Guardian #1)
Please make sure email is accurate, since this is our primary way to communicate information.
Your answer
Parent/Guardian Information
Email is important if you with to receive emails form the Crew Club. This is our primary source of communication. PLEASE check your entries to be sure they are accurate. Thank you!
Parent/Guardian #1
Your answer
Additional Email (Parent Guardian #1)
Please make sure email is accurate, since this is our primary way to communicate information.
Your answer
Cell # (Parent/Guardian #1) (xxx-xxx-xxxx)
Your answer
Parent Guardian #2
Your answer
Email (Parent Guardian #2)
Please make sure email is accurate, since this is our primary way to communicate information.
Your answer
Additional Email (Parent/Guardian #2)
Please make sure email is accurate, since this is our primary way to communicate information.
Your answer
Cell # (Parent/Guardian #2) (xxx-xxx-xxxx)
Your answer
Emergency Contact
(should parent/guardian not be reached)
Your answer
Relationship to Rower
Your answer
Emergency Contact Phone # (xxx-xxx-xxxx)
Day
Your answer
Emergency Contact Phone # (xxx-xxx-xxxx)
Evening
Your answer
Consent for Treatment
Health History: Include allergies, surgeries, injuries, long-term illnesses, heart trouble, concussions, asthma and other breathing difficulties, etc. If there is anything else that might be helpful in coaching your child, please include here as well. Include dates where appropriate.
Your answer
Current medications:
Your answer
Date of Last Physical
MM
/
DD
/
YYYY
In order to participate, we need an updated proof of the rower's physical dated within two years of the start of the program for which you are registering. You may mail the document, instructions will be provided upon completion of your registration.
Required
Date of Last Tetanus
MM
/
DD
/
YYYY
Preferred Physician
Your answer
Physician Phone # (xxx-xxx-xxxx)
Your answer
Preferred Hospital
Your answer
Read and scroll down to accept the following agreement:
MEDICAL RELEASE I/We hereby give permission for the care and emergency treatment of my son/daughter (camp participant) by physicians, athletic trainers, coaches, EMTs, or hospital emergency personnel for treatment of any illness or injury resulting from or affecting his/her athletic participation.
Required
Insurance Information
Health Insurance Company
Your answer
Policy Number
Your answer
Group #
Your answer
Phone # (xxx-xxx-xxxx)
Your answer
Media Release
MEDIA RELEASE: I give my permission / I do not give my permission for photographs, videos, and interviews to be taken of the above named individual during Bedford Crew activities. It is my understanding that any such images or interview content or portions thereof may be used for public view. Further, I hereby authorize the Club to release/use my name in conjunction with the aforementioned images in recognized, responsible publications or media outlets, on Bedford Crew's website and as otherwise reasonable responsibly approved by the Bedford Crew Club. The purpose of this may be in conjunction with a general news release such as sports reporting or more specifically for recruiting or as part of publicity and marketing campaigns, fundraising efforts, or tother Bedford Crew initiatives.
Required
Parental Release
PARENTAL RELEASE: I/WE give permission for my son/daughter to attend and participate in the Bedford Crew Rowing Camp from July 18, 2016 July 22, 2016.
Required
I authorize the staff of the camp to use their best judgement in allowing my child to receive emergency/medical or surgical treatment if necessary. I understand that every effort will be make to contact me prior to such action.
PLEASE BE ADVISED THAT YOUR CHILD MUST BE IN GOOD HEALTH WHEN ARRIVING AT CAMP. THE DUTIES OF CAMP PERSONNEL CANNOT INCLUDE PROVIDING MEDICAL CARE FOR CAMPERS ARRIVING AT CAMP WITH PRE-EXISTING CONDITIONS. I hereby certify that, to the best of my knowledge, the medical information is complete and correct. Agree to assume all risk of personal injury arising from participating in this camp, understanding that this sport does involve the potential for injury. Agree not to hold the staff responsible for any injury sustained during camp participation. Agree not to bring suit against camp staff or Bedford Crew Club for any injury sustained. Agree to allow Camp Director to use sound judgement in obtaining necessary medical care, at the expense of the parent. Agree to accept any decisions made by the Camp Director in terminating attendance due to unacceptable behavior. Certify that enrolled camper is capable of swimming a minimum of 250 yards without aid.
Required
Permission to share email/address info?
Giving permission to share information for the coordination of carpools between families.
Required
US Rowing Release of Liability
IN CONSIDERATION of being given the opportunity to participate in any USRowing activity, including scheduled, supervised club activities, and registered regattas, during the policy term 1/1/16 – 12/31/16, I, for myself, my personal representatives, assigns, heirs, and next of kin. 1. I ACKNOWLEDGE, agree and represent that I understand the nature of Rowing Activities, both on water and land based, and that I am qualified, in good health, and in proper physical condition to participate in such Activity. 2. I FULLY UNDERSTAND that: (a.) ROWING ACTIVITIES INVOLVE RISKS AND DANGERS of serious bodily injury, including permanent disability, paralysis and death (“Risks”); (b.) these Risks and dangers may be caused by my own actions, or inactions, the actions or inactions of others participating in the Activity, the condition in which the Activity takes place, or the negligence of the Release named below; (c.) there may be other risks and social and economic losses either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation in the Activity. 3. I AGREE AND WARRANT that I will examine and inspect each Activity in which I take part as a member of USRowing and that, if I observe any condition which I consider to be unacceptably hazardous or dangerous, I will notify the proper authority in charge of the Activity and will refuse to take part in the Activity until the condition has been corrected to my satisfaction. 4. I HEREBY RELEASE, discharge, and covenant not to sue USRowing, the Club, the Regatta, their administrators, directors, agents, officers, volunteers and employees, other participating regatta organizers, any sponsors, advertisers, and if applicable, owners and lessors of premises, on which the Activity takes place, (each considered one of the Releasees herein) from all liability, claims, demands, losses or damages on my account caused or alleged to be caused in whole or in part by the negligence of the Releasee or otherwise, including negligent rescue operations; and I further agree that if, despite this release and waiver of liability, assumption of risk, and indemnity agreement, I, or anyone on my behalf, makes a claim against any of the Releasees, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS each of the Releasees from any litigation expenses, attorney fees, loss, liability, damage, or cost which any may incur as a result of such claim, to the fullest extent permitted by law. PLEASE DO NOT CHANGE OR ALTER THE WORDING ON THIS WAIVER WITHOUT PRIOR APPROVAL FROM US ROWING I have read this agreement, fully understand its terms, understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid, the balance, notwithstanding, shall continue in full force and effect.
PARENTAL CONSENT (if participant is under the age of 18). AND I, the minor’s parent and/or legal guardian, understand the nature of rowing activities and the minor’s experience and capabilities and believe the minor to be qualified to participate in such activity. I hereby release, discharge, covenant not to sue, and AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS each of the Releasees from all liability, claims, demands, losses, or damages on the minor’s account caused or alleged to be caused in whole or part by the negligence of the Releasees or otherwise, including negligent rescue operations, and further agree that if, despite this release, I, the minor, or anyone on the minor’s behalf makes a claim against any of the above Releasee, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS each of the Releasees from any litigation expenses, attorney fees, loss, liability, damage, or cost any may incur as the result of any such claim, to the fullest extent permitted by law.
Required
BEDFORD CREW RELEASE OF LIABILITY
IN CONSIDERATION of being given the opportunity to participate in any Bedford Crew Club and Amoskeag Rowing Club activity, including scheduled, supervised club activities, and registered regattas, during the policy term 1/1/16 – 12/31/16, I, for myself, my personal representatives, assigns, heirs, and next of kin. 1. I ACKNOWLEDGE, agree and represent that I understand the nature of Rowing Activities, both on water and land based, and that I am qualified, in good health, and in proper physical condition to participate in such Activity. 2. I FULLY UNDERSTAND that: (a.) ROWING ACTIVITIES INVOLVE RISKS AND DANGERS of serious bodily injury, including permanent disability, paralysis and death (“Risks”); (b.) these Risks and dangers may be caused by my own actions, or inactions, the actions or inactions of others participating in the Activity, the condition in which the Activity takes place, or the negligence of the Release named below; (c.) there may be other risks and social and economic losses either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation in the Activity. 3. I AGREE AND WARRANT that I will examine and inspect each Activity in which I take part as a member of Bedford Crew Club and that, if I observe any condition which I consider to be unacceptably hazardous or dangerous, I will notify the proper authority in charge of the Activity and will refuse to take part in the Activity until the condition has been corrected to my satisfaction. 4. I HEREBY RELEASE, discharge, and covenant not to sue Bedford Crew Club, Amoskeag Rowing Club, other rowing Clubs with whom we compete or share equipment, the Regatta, their administrators, directors, agents, officers, volunteers and employees, other participating regatta organizers, any sponsors, advertisers, and if applicable, owners and lessors of premises, on which the Activity takes place, (each considered one of the Releasees herein) from all liability, claims, demands, losses or damages on my account caused or alleged to be caused in whole or in part by the negligence of the Releasee or otherwise, including negligent rescue operations; and I further agree that if, despite this release and waiver of liability, assumption of risk, and indemnity agreement, I, or anyone on my behalf, makes a claim against any of the Releasees, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS each of the Releasees from any litigation expenses, attorney fees, loss, liability, damage, or cost which any may incur as a result of such claim, to the fullest extent permitted by law. I have read this agreement, fully understand its terms, understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid, the balance, notwithstanding, shall continue in full force and effect.
PARENTAL CONSENT (if participant is under the age of 18). AND I, the minor’s parent and/or legal guardian, understand the nature of rowing activities and the minor’s experience and capabilities and believe the minor to be qualified to participate in such activity. I hereby release, discharge, covenant not to sue, and AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS each of the Releasees from all liability, claims, demands, losses, or damages on the minor’s account caused or alleged to be caused in whole or part by the negligence of the Releasees or otherwise, including negligent rescue operations, and further agree that if, despite this release, I, the minor, or anyone on the minor’s behalf makes a claim against any of the above Releasee, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS each of the Releasees from any litigation expenses, attorney fees, loss, liability, damage, or cost any may incur as the result of any such claim, to the fullest extent permitted by law.
Required
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