waiver - loras college women's basketball camps...july 29 - aug 1, 2019 please read this form...

2
LORAS WOMEN’S BASKETBALL SKILLS CAMP JULY 29-AUG 1, 2019 DUBUQUE, IOWA 1450 Alta Vista St. | Dubuque, IA 52001-4327 2019 WOMEN’S BASKETBALL SKILLS CAMP JULY 29-AUG 1, 2019 DUHAWKS.COM INDEMNIFICATION AGREEMENT WAIVER AND RELEASE OF ALL CLAIMS PERMISSION TO SECURE TREATMENT Loras College Women’s Basketball Skills Camp July 29 - Aug 1, 2019 Please read this form carefully and be aware that by participating in the Loras College Women’s Basketball College Prep Camp on July 29- Aug 1, 2019 (hereinafter Event) you will be waiving and releasing all claims for injuries, agreeing to indemnify, hold harmless and defend Loras College from all claims arising out of such injuries even if caused by Loras College and authorizing Loras College to obtain emergency healthcare at your expense. I, on behalf of myself and, on behalf of any child/ward of mine participating in the Event as well as any parent/guardians of such child/ward (hereinafter individually and collectively referred to as “Participant”), acknowledge understanding of the requisite skills and qualifications necessary to properly and safely participate in the Event and hereby agree to assume the full risk of any injuries, including death, damages or loss regardless of severity, which Participant may sustain as a result of, arising out of, connected with, or in any way associated with the Event. Participant agrees to waive and relinquish all claims Participant may have as a result of the Event against Loras College and its employees and agents and does hereby fully release and discharge Loras College and its employees and agents from any and all claims for injuries, including death, damage or loss which Participant may have or which may accrue to Participant as a result of, or arising out of, connected with, or in any way associated with the Event, even if caused by the negligence of Loras College, its employees or agents. Participant further agrees to INDEMNIFY AND HOLD HARMLESS AND DEFEND Loras College and its employees and agents from any and all claims for injuries, including death, damages and losses sustained by Participant as a result of, arising out of, connected with, or in any way associated with the Event, even if caused by the negligence of Loras College, its employees or agents.. Participant further understands that Loras College does not carry insurance for injuries sustained by Participant. Therefore, Participant must look to their own health insurance policy for any injuries sustained in connection with or arising out of this Event. Participant’s failure to purchase health insurance coverage does not make Loras College responsible for payment of medical or other expenses. In the event of an emergency, Participant authorizes Loras College to secure any treatment deemed necessary from any licensed hospital, physician, and/or medical personnel and agrees to be responsible for payment of any and all services rendered. If any provision herein is held invalid or unenforceable for any reason, Participant understands and agrees that the remaining provisions will continue in full force and effect. Participant has read and fully understands this entire document and declares that all information supplied by Participant is accurate and current. Participant Name(s) :_______________________________________ _________________ (Parent) (Child) Address: _________________________________________________ __________________ Participant Signature(s): ____________________________________ ________________ (Must be signed by Parent or Guardian if any Participant is a minor) Relationship to Participant (if Participant is a minor): _________________________________________________________ __________________ WAIVER @DUHAWKWBB LORAS COLLEGE WOMEN’S BASKETBALL

Upload: others

Post on 20-Oct-2020

1 views

Category:

Documents


0 download

TRANSCRIPT

  • LORAS WOMEN’S BASKETBALL

    SKILLS CAMPJULY 29-AUG 1, 2019

    DUBUQUE, IOWA

    145

    0 A

    lta V

    ista

    St.

    | D

    ub

    uq

    ue, IA

    52

    00

    1-4

    32

    7

    20

    19 W

    OM

    EN

    ’S

    BA

    SK

    ET

    BA

    LL

    S

    KIL

    LS

    CA

    MP

    JU

    LY 2

    9-A

    UG

    1, 2

    019

    DUHAWKS.COM

    INDEMNIFICATION AGREEMENTWAIVER AND RELEASE OF ALL CLAIMSPERMISSION TO SECURE TREATMENT

    Loras College Women’s Basketball Skills CampJuly 29 - Aug 1, 2019

    Please read this form carefully and be aware that by participating in the Loras College Women’s Basketball College Prep Camp on July 29- Aug 1, 2019 (hereinafter Event) you will be waiving and releasing all claims for injuries, agreeing to indemnify, hold harmless and defend Loras College from all claims arising out of such injuries even if caused by Loras College and authorizing Loras College to obtain emergency healthcare at your expense.

    I, on behalf of myself and, on behalf of any child/ward of mine participating in the Event as well as any parent/guardians of such child/ward (hereinafter individually and collectively referred to as “Participant”), acknowledge understanding of the requisite skills and qualifications necessary to properly and safely participate in the Event and hereby agree to assume the full risk of any injuries, including death, damages or loss regardless of severity, which Participant may sustain as a result of, arising out of, connected with, or in any way associated with the Event.

    Participant agrees to waive and relinquish all claims Participant may have as a result of the Event against Loras College and its employees and agents and does hereby fully release and discharge Loras College and its employees and agents from any and all claims for injuries, including death, damage or loss which Participant may have or which may accrue to Participant as a result of, or arising out of, connected with, or in any way associated with the Event, even if caused by the negligence of Loras College, its employees or agents.

    Participant further agrees to INDEMNIFY AND HOLD HARMLESS AND DEFEND Loras College and its employees and agents from any and all claims for injuries, including death, damages and losses sustained by Participant as a result of, arising out of, connected with, or in any way associated with the Event, even if caused by the negligence of Loras College, its employees or agents..

    Participant further understands that Loras College does not carry insurance for injuries sustained by Participant. Therefore, Participant must look to their own health insurance policy for any injuries sustained in connection with or arising out of this Event. Participant’s failure to purchase health insurance coverage does not make Loras College responsible for payment of medical or other expenses.

    In the event of an emergency, Participant authorizes Loras College to secure any treatment deemed necessary from any licensed hospital, physician, and/or medical personnel and agrees to be responsible for payment of any and all services rendered. If any provision herein is held invalid or unenforceable for any reason, Participant understands and agrees that the remaining provisions will continue in full force and effect.

    Participant has read and fully understands this entire document and declares that all information supplied by Participant is accurate and current.

    Participant Name(s) :________________________________________________________ (Parent) (Child)Address: ___________________________________________________________________

    Participant Signature(s): ____________________________________________________(Must be signed by Parent or Guardian if any Participant is a minor)

    Relationship to Participant (if Participant is a minor):___________________________________________________________________________

    WAIVER

    @DUHAWKWBBLORAS COLLEGE WOMEN’S BASKETBALL

  • GRADESGrades 3-8 (Based on fall 2019-20 school year)

    SCHEDULE8:30 a.m. - 1:30 p.m. with lunch served in the Cafe

    LOCATIONAll activities held in the Athletic & Wellness Center(1600 Cox Street, Dubuque, IA 52001-4327)

    FORMATThe main focuses of this camp are on communication, team building, energy, and the basic fundamentals of basketball. Each camper will have the opportunity to improve on her individual skills, both offensively and defensively, work with ball handling, passing, shooting, rebounding, and 5-on-5 game play. For more information, check out, www.lorasgirlsbasketballcamp.com

    COST$130/participantIncludes: meals, t-shirt, and prizesWe are unable to refund cancellations after July 16, 2019.Wrap around child care provided after camp for $5/hour until 5:00 p.m.

    DEADLINERegistration (by mail or online), payment, and signed waiver due by July 16, 2019.

    NEED MORE INFO?Please call:Justin HeinzenCamp DirectorHead Women’s Basketball [email protected]

    LO

    RA

    S C

    OL

    LE

    GE

    WO

    ME

    N’S

    BA

    SK

    ET

    BA

    LL

    CA

    MP

    RE

    GIS

    TR

    AT

    ION

    F

    OR

    MN

    am

    e:

    Gra

    de

    (F

    all 2

    019

    ): 3

    4

    5

    6

    7

    8

    Ad

    dre

    ss:

    Sta

    te:

    Zip

    :

    Cit

    y:

    H

    om

    e P

    ho

    ne

    :

    Em

    ail (

    Re

    qu

    ire

    d)

    Pare

    nt(

    s)/G

    uard

    ian

    (s)

    Nam

    e(s

    ):

    T-S

    hir

    t S

    ize

    : Y

    M Y

    L S

    M

    L

    X

    L X

    XL

    If t

    here

    are

    any s

    pecifi

    c m

    ed

    ical si

    tuati

    on

    s th

    at

    sho

    uld

    be k

    no

    wn

    or

    acti

    vit

    ies

    that

    sho

    uld

    be r

    est

    ricte

    d, c

    on

    tact

    the

    cam

    p b

    y a

    ttach

    ing

    th

    e in

    form

    ati

    on

    wit

    h t

    his

    ap

    plic

    ati

    on

    or

    by c

    alli

    ng

    Ju

    stin

    Hein

    zen

    (C

    am

    p D

    irecto

    r), 5

    63

    .58

    8.7

    94

    7.

    To r

    eg

    iste

    r: M

    US

    T fi

    ll o

    ut

    bo

    th s

    ides

    of

    this

    fo

    rm a

    nd

    sen

    d t

    he c

    om

    ple

    ted

    fo

    rm a

    nd

    paym

    en

    t w

    ith

    ch

    eck p

    ayab

    le t

    o

    Lo

    ras

    Co

    lleg

    e W

    om

    en

    ’s B

    ask

    etb

    all

    by J

    uly

    16

    , 20

    19 t

    o:

    Ju

    stin

    Hein

    zen

    , Cam

    p D

    irecto

    r, Lo

    ras

    Co

    lleg

    e M

    ail

    #15

    5, 1

    450

    Alt

    a V

    ista

    St.

    , Du

    bu

    qu

    e, I

    A 5

    20

    01-

    4327

    STAFF

    CAMP INFO

    DUHAWKS.COM

    JUSTIN HEINZENHEAD COACH / CAMP DIRECTOR

    Heinzen begins his 13th season as head

    women’s basketball coach at Loras College.

    During his tenure at the helm of the Duhawks, Heinzen has

    compiled an overall coaching record of 180-116 which includes

    11-straight appearances in the Iowa Intercollegiate Athletic

    Conference Tournament.

    During the 2018-19 season, Heinzen led the Duhawks to their

    third trip to the NCAA Tournament in six seasons.

    Heinzen graduated from Wisconsin Lutheran in 2004 with a

    bachelor’s degree in American History and a minor in political

    science. Today, the Manitowoc, Wis. native resides in Dubuque

    with his wife, Kristina, daughter, Paityn, and son, Brayden.

    @DUHAWKWBB LORAS COLLEGE WOMEN’S BASKETBALL

    Kent begins her third season as the primary

    assistant at her alma mater. During her time

    at Loras, Kent was an All-Conference selection and appeared

    in 106 games, averaging 7.4 points per game and was a 39.5

    percent shooter from the floor. Following her playing career,

    Kent was a volunteer assistant for Justin Heinzen during the

    2013–14 season in which Loras won the IIAC Regular Season

    Championship and Tournament Championship and advanced

    to the NCAA Tournament. Kent currently resides in Dubuque.

    BRIT KENTASSISTANT COACH