Brent Hayden Swim Camp Registration Forms

BRENT HAYDEN SWIM CAMP 2015
REGISTRATION FORM
Instructors:
Brent Hayden & Nadina Zarifeh
Location:
H20 Adventure and Fitness Center, 2075 Gordon Drive, Kelowna BC, V1W 5J2
Dates:
Saturday May 16 & Sunday May 17, 2015
Clinics:
Beginner Clinic (x2 - 1 hour session & classroom) –new to swim club, must be able to swim 50m on own – age 6+
2 day Boot Camp (8 hours pool training; dryland and classroom plus bonus starts/turns session)
-this is for swimmers who have competed 2+yrs and comfortable in all strokes/turns/starts
-questions about what group you are in? Please contact Michelle (Schuelers@shaw.ca)
Cost:
Beginner Group: $105.00/swimmer
Junior/Senior Group: $265.00/swimmer
BHSC swim caps will be provided for each swimmer & a Goodie Bag. T-shirts are available for purchase ($25).
Payment:
Please make cheque payable to Ogopogo Summer Swim Club and return forms to Ogopogo drop box (located in
H2O lobby by trophy case) OR email forms to Michelle Schueler (Schuelers@shaw.ca).
PayPal payment option will be available on the Ogopogo website: www.ogopogoswimclub.com
Refunds:
Any cancellations within 14 days prior to the start of the event are non-refundable.
Further Info:
Space is limited so register today! Please contact Michelle if you have questions: Schuelers@shaw.ca
PLEASE FILL OUT THE REGISTRATION FORM AND RETURN WITH SIGNED WAIVER AND PAYMENT
--------------------------------------------------------------------------------------------Swimmer’s Name: ______________________________________________
Age: _________
Parent/Guardian’s Name (if under 18 years of age):_____________________________________
Address: ________________________________ City: ___________________ Prov: ______
Home Phone: (_______)___________________ Cell: (_______)___________________
Contact Email:____________________________________
T-Shirt* (+$25.00 - please circle):
YES*
NO
*Shirt Size (if yes - please circle):
YM
YL
S
M
L
XL
Swim Club: ______________________________________
Division: _____
100m Freestyle Time: ____________
Camp Group (please circle): Beginner
Junior
Senior
Emergency Contact Person and Cell Number: ____________________________________________________________________
Health Concerns (including any medical or behavioural concerns staff should be aware of. Please include allergies, life threatening
conditions, disabilities, or if extra assistance is required. This information helps staff determine if we can reasonably accommodate the
swimmer:
___________________________________________________________________________________________________________
BRENT HAYDEN SWIM CAMPS
WAIVER OF LIABILITY
PARENT/GUARDIAN CONSENT, ACKNOWLEDGEMENT OF RISK, WAIVER, RELEASE AND INDENMITY NOTICE TO
PARENT/GUARDIAN
It is a condition to the Swimmer’s participation in the Activity that you, the undersigned Parent/Guardian of the Swimmer, must carefully read and
understand this document and sign it to acknowledge that you have read and understand it and that you understand that the Swimmer’s participation in
the Activity will expose the Swimmer to risks of harm and that you accept full responsibility for exposing the Swimmer to such risks.
All references herein to “BHSC” means the Brent Hayden Swim Camps and includes any society or association involved in the operation of and/or
provision of programs or services by the BHSC and all of their respective instructors, sponsors, officials, directors, officers, employees, volunteers,
agents and assigns.
PARENT/GUARDIAN RESPONSIBILITY FOR SWIMMER
I, the undersigned Parent/Guardian of the Swimmer, understand and accept that, in respect of the Swimmer’s participation in the Activity, it is my
responsibility: (1) to ensure that I consider and understand the risks, dangers, hazards and consequences of injury inherent in the Activity; (2) to
determine, taking into consideration those risks and the Swimmer's behavioural characteristics, physical health and abilities, whether the Swimmer
should be allowed to participate in the Activity; (3) to ensure that the Swimmer is appropriately covered by medical insurance for any harm occurring
in the Activity; and (4) to provide emergency medical information regarding the Swimmer as required in this document.
AWARE OF RISKS
I AM AWARE OF AND NOW FREELY ACCEPT AND ASSUME FOR ME AND THE SWIMMER RESPONSIBILITY FOR ALL RISKS TO THE
SWIMMER IN CONNECTION WITH HIS OR HER PARTICIPATION IN THE ACTIVITY, INCLUDING AS FOLLOWS: (1) the Swimmer's
participation in the Activity, even if the Swimmer possesses behavioural characteristics, physical health and abilities appropriate for the Activity, poses
risks of harm to the Swimmer; (2) the nature of the Activity is such that the BHSC cannot identify all risks associated with the Activity and cannot
guarantee that BHSC staff participating in the Activity will not make errors therein or that other swimmers participating in the activities will not cause
injuries therein to others that staff can or might be able to prevent.
I, THE UNDERSIGNED PARENT/GUARDIAN, AM THE PARENT AND/OR LEGAL GUARDIAN OF THE CHILD AND FOR THE SWIMMER
I HEREBY CONSENT TO HIM OR HER PARTICIPATING IN THE ACTIVITY, AND, FOR MYSELF AND THE SWIMMER, IN RETURN FOR
THE BHSC ALLOWING THE SWIMMER TO PARTICIPATE IN THE ACTIVITY:
1)
I HEREBY WAIVE ALL LEGAL RIGHTS TO SUE AND ANY AND ALL CLAIMS which I or the Swimmer or our respective successors
and assigns may have against BHSC in connection with any loss, injury, damage or expense that I or the Swimmer may suffer, incur or may
suffer, incur or experience in connection with the Swimmer’s participation in the Activity; and
2)
I HEREBY RELEASE BHSC from any and all liability for any complaints, demands, claims, actions, suits, judgments and orders for any
and all losses, injuries, damage or expenses I or the Swimmer may suffer, incur or experience in connection with the Swimmer participation
in the Activity; and
3)
FOR MYSELF, I AGREE TO INDEMNIFY BHSC for and hold it harmless from any and all losses, injuries, damages and expenses of any
kind that BHSC may suffer, incur or experience and for any and all complaints, demands, claims, actions, suits, judgments and orders for
any and all losses, injuries, damages or expenses of any kind anyone else may suffer, incur or experience in connection with the Swimmer’s
participation in the Activity.
In signing this document and permitting the Swimmer to participate in the Activity, I do not rely upon any oral or written statements, promises or other
communications made by the BHSC or any third party other than that set out in this document. This document will be exclusively governed by and
interpreted in accordance with the laws of British Columbia and no court outside British Columbia will have any jurisdiction over this Registration
Form, the Activity, or any of the matters arising from them.
I HAVE READ AND I UNDERSTAND THIS DOCUMENT
DATED at
Athlete Signature (if 13 years and older)
this
day of
, 201
Parent Signature (required unless athlete is 19 or
over)
Brent Hayden Swim Camp - May 16/17th
Brent Hayden Swim Camps (BHSC) is a camp style clinic run by one of Canada’s greatest swimmers and the
fastest swimmer in Canadian history. As a London 2012 Olympic Games Bronze Medalist, Brent Hayden is the
only Canadian to medal at the Olympics in the 100m freestyle. In 2007, he became the first Canadian in 21
years to win Gold at the World Championships. His international career spanned 10 years (2002-2012) which
took him to three Olympic Games and six World Championships. He holds six Canadian Records and held two
World Records. In 2007, he was voted Canadian Athlete of the Year and was a finalist for the same award in
2012. In 2013, he was inducted into the BC Sport Hall of Fame. He is an expert in stroke, start and turn
technique and has valuable knowledge in performance preparation, whether it’s mental, physical, or
nutritional. Ogopogo Swim Club hosted Brent and Nadina last May - It was a huge success and fun for all!!! 
What you will get out of this camp:
-Hands on coaching; working specifically on stroke, start & turn techniques with personal feedback
-In-water demonstrations by Olympian Brent Hayden.
-Insight to mental preparation/sport psychology.
-Guidelines for high performance nutrition.
DAY 1: SATURDAY MAY 16th
Beginner Group Session 1:
11:15-11:45 – Sign-in/group picture/autographs/pictures for this group
Beginner activation 11:45-12:00pm
12-12:45 in water training with Brent
3:45-4:50pm – nutrition education talk in classroom with Jr/Sr Group
Session 1: Jr and Sr Group
12:45-1:00pm Arrival on deck and sign-in
1:00-1:30pm Dryland/activation
1:30-3:30 in water training plus working on turns & breakouts
3:40-4:50pm – snack, classroom time - nutrition talk
Session 2: Jr and Sr Group: 5-7pm in water training
Day 2: SUNDAY MAY 17th
Beginners Group Session 2:
Arrival 11:40am, 11:45-12pm Activation
12-12:45 in water training with Brent
3:45-4:50pm –sports psychology and race preparation talk in classroom with Jr/Sr Group
Session 1: Jr and Sr Group
1:00-1:30 -Dryland/activation
1:30-3:30 in water training
3:45-4:50pm – snack, sports psychology and race prep talk in classroom, pictures/autographs for this group
Session 2: Jr and Sr Group: 5-7pm in water training plus working on dive starts