2013 Chief Sealth Soccer Skills Camp

WAIVER AND CONSENT FOR MEDICAL CARE
CAMP LOCATION & DIRECTIONS
I, _______________________________________________, authorize
all medical, surgical, diagnostic and hospital procedures as may be
performed or presented by a physician for
___________________________________ , if I cannot be reached in
case of an emergency.
You are invited to attend...
Date_________ Signature ____________________________________
Amateur Athletic Minor Waiver
In consideration of being allowed to participate in any way in Sealth
Soccer Camp’s athletic/sports program, and related events and activities, the undersigned:
1. Agree that the parent(s) or legal guardian(s)will instruct the minor
participant that prior to participating he or she should inspect the facilities and equipment to be used, and if the participant believes anything is unsafe, he or she should immediately advise his or her coach or
supervisor of such condition(s) and refuse to participate.
2. Acknowledge and fully understand that each participant will be engaging in activities that involve risk or serious injury, including permanent disability and death, and severe social and economic losses which
might result only from their own actions, inactions or negligence, but
the action, inaction, or negligence of others, the rules of play, or the
condition of the premises or of any equipment used. Further, that there
may be risks not known to us or not reasonably foreseeable at this time.
3. Assume all the foregoing risk and accept personal responsibility for
the damages following such injury, permanent disability, or death.
Photo courtesy Seattle Times
Camp Location
The 2013 Chief Sealth Soccer Skills Camp will take place at the
Southwest Athletic Complex, directly across the street from Chief
Sealth International High School.
Driving Directions
- Take Delridge Way SW Exit from West Seattle Bridge.
- Head South approximately 2.5 miles on Delridge Way SW
- Turn Right on SW Thistle St. Located at 2600 SW Thistle St.
4. Release, waive, discharge and covenant not to sue the Seattle Public
School District, ASB, or any of the staff operating and organizing Sealth
Soccer Camp, all of which are hereafter referred to as “releasees” from
any and all liability to each of the undersigned, his or her heirs and next
of kin for any and all claims, demands, losses or damages on account
of injury, including death or damage to property, caused or alleged to
be caused in whole or in part by the negligence of the releasees or
otherwise.
July 22nd-26th
9:00am-4:00pm daily
_________________________________________ Date____________
Parent or Guardian (Signature/Relationship)
_________________________________
Printed Name of Participant
Open to all boys and
girls, headed into
grades 3rd-9th.
All skill levels are
invited.
I/WE HAVE READ THE ABOVE WAIVER AND RELEASE,
UNDERSTAND THAT I/WE GIVE UP SUBSTANTIAL RIGHTS BY SIGNING IT
AND SIGN IT VOLUNTARILY
_________________________________________
Printed Name of Parent or Guardian
2013 Chief Sealth
Soccer Skills Camp
Follow Sealth Athletics
CHIEF SEALTH INTERNATIONAL
2013 SOCCER SKILLS CAMP
REGISTRATION FORM
Please complete the following waiver and application.
Mail application and payment to:
Chief Sealth International High School
Attn: Sam Reed
2600 SW Thistle
Seattle, WA 98126
Photo courtesy West Seattle Herald
Photo courtesy West Seattle Herald
CAMP PHILOSOPHY / ABOUT US
When: July 22nd-26th (Mon-Fri)
Camp Philosophy
Where: Southwest Athletic Complex (see directions)
This is the 1st year of the Chief Sealth Soccer Skills Camp. Modelled after our long-standing basketball skills camp, now in it’s
16th year, the philosophy of the camp is to provide a positive
and fun learning experience to youth by exposing them to the
fundamentals of soccer and life, including the values and qualities that we feel are necessary to be successful in these arenas.
Who: Boys and Girls grades 3-9 (entering fall 2013)
Cost: $100 (1st year introductory price)
Checks Payable to: Friends of Sealth
Time: 9:00am-4:00pm each day
Check-in opens at 8:00am Monday,
camp opens at 8:45am Tues-Fri)
The camp will focus on three pillars, 1) skill development, 2)
teamwork and leadership, and 3) life values and traits. We at
Chief Sealth feel that in order to truly be successful studentathletes we must work equally in all three areas.
About Us
The camp will be directed by long-time boys and girls Head
Coach Ron Johnson and Athletic Director Sam Reed. Johnson,
who was named Metro Sound Boys Coach of the Year in both
2012 and 2013, has been the Seahawks head coach for 16 seasons, and has taken the boys to the WIAA 3A state tournament
in each of the past two seasons. On the girls side, he has been
the head coach since the program began and has built the program into a league contender, as the 2012 girls team finished
4th in the Metro League.
Reed, the WIAA District 2 Athletic Director of the Year, has been
at Chief Sealth since 2007. Under his leadership Sealth Athletics has participation nearly triple, all 15 WIAA sports advance to
the postseason, 7 different Metro League Coaches of the Year
and numerous other program successes. Further, he has years
of prior experience running sport camps at the state and regional level.
Coaching
The camp will be led by both current and past members of
the Chief Sealth boys and girls soccer teams. They will provide
coaching by exposing campers to the fundamental skills of
the game through proven coaching methods. Our camp does
not guarantee success as a player, but it will expose campers
to the ingredients necessary to becoming a skilled player and
successful high school student-athlete.
Accommodations
Each camper will receive a camp t-shirt. Campers must provide their own lunch. There will be a camp store available
where hotdogs, snacks, candy, and beverages can be purchased. It is recommended that each camper bring his/her
own water bottle, as water stations will be available for fillup. Campers should also dress appropriately and consider
sunscreen as we will be outside the entirety of the camp. The
camp is not responsible for lost or stolen items.
It is requested that campers NOT bring their own soccer ball.
Questions? e-mail Sam Reed at sjreed@seattleschools.org
Name: ____________________________________________
Address: __________________________________________
City: _______________________________State:__________
Zip:______________
Phone: ___________________________________________
E-mail Address (REQUIRED FOR PRIMARY COMMUNICATION):
__________________________________________________
Emergency Contact: ________________________________
Emergency Phone: _________________________________
Grade in fall of 2013: ________ T-Shirt Size:____________
Please specify Adult or Youth size: S, M, L, XL, XXL)
Have you participated in a past Sealth Basketball & Life Skills
Camp? Y / N (circle one)
How did you hear about our program?
_________________________
(Sealth Website, Local Media, Friend Reference, etc...)
Are there any medical concerns we should know about
this camper?