pocock rowing center junior team: spring

POCOCK ROWING CENTER
JUNIOR TEAM: SPRING
The PRC Junior Team spring season is February 2-May 20, 2015.
Practices are Monday-Friday from 4-6:30pm and are held at the Pocock Rowing Center.
Practices are held in the rain, the sun, the wind, and the fog! Athletes should come dressed or prepared for the
weather and bring appropriate changes of clothes and footwear for both land and water training.
If practice needs to be cancelled due to weather or other emergency, an email will be sent to contact the
athletes and parents as soon as possible.
Uniforms are available for purchase through the JL online team store through February 8, 2015. Orders that
need to be placed after the team store closes can be placed directly with the vendor, JL. Uniforms will be
delivered by the vendor to the Pocock Rowing Center and distributed to the athletes when they are received in
mid-March.
Documents Required for ALL members prior to participation:
____ Junior Athlete Code of Conduct
____ Notarized Junior Medical Release and Temporary Surrogate Form (for travel to Canada)
____ Medical History
____ Float Test administered by certified life guard (valid for 3 years)
____ Local Regatta Waiver/USRowing Waiver
JUNIOR TEAM REGATTA and EVENT SCHEDULE (subject to change)
1-­‐31 2-­‐28 3-­‐1 3-­‐7 3-­‐15 3-­‐21 3-­‐22 3-­‐26/3-­‐28 4-­‐4 4-­‐24/4-­‐26 5-­‐2 5-­‐14/5-­‐17 6-­‐12/6-­‐15 NW Ergomania Indoor Erg Race PRC Junior Social PRC Junior Ergathon All Varsity Scrimmage (GLC, HNA) Varsity Girls’ Scrimmage (ERA) Green Lake Spring Regatta (Novices) All Varsity Scrimmage (SRA) San Diego Crew Classic (select Varsity) Husky Open Brentwood Regatta Opening Day (qualified crews) USRA NW Junior Regionals USRA Junior Nationals (qualified crews) Magnuson Park, Seattle PRC Fremont Sunday Market PRC PRC Green Lake, Seattle Sammamish San Diego, CA Seattle Mill Bay, Canada Seattle Vancouver, WA Sarasota, FL JUNIOR ATHLETE CODE OF CONDUCT 1.
I understand that as a member of the Pocock Rowing Center Junior Team or Middle School Club, my behavior is a reflection on the GPRF and Pocock Rowing Center and I will behave respectfully and responsibly. 2. I will be respectful of GPRF/PRC coaches, teammates, volunteers, chaperones and other participants. 3. I agree to accept and carry out instructions of the GPRF/PRC staff, coaches, and chaperones and report any problems to a coach, GPRF/PRC staff member, or chaperone. 4. I understand that as a member of the PRC Junior Team or Middle School Club, I am only allowed to use the Pocock Rowing Center facility and equipment during regularly scheduled, coached practices or regattas. 5. I will be respectful of other people’s possessions and property and will refrain from activities that may damage either. 6. I understand that I am financially responsible for any damage I may cause when disobeying rules or instructions by GPRF/PRC coaches, regatta officials, volunteers or chaperones. 7. I agree to attend and participate in all scheduled practices and activities, and I agree to communicate scheduled and unscheduled absences from practice or events directly to my coach. 8. I understand that I cannot come to practice if I did not attend school or was sent home from school due to illness; I will contact my coach to communicate my absence from practice. 9. I understand that if I am sent home from practice or a team event due to a violation of the code of conduct, it will be at my/my parents’ expense. 10. I understand that ANY of the following acts are strictly prohibited and will lead to immediate disciplinary action: a. Commission of a felony b. Possession or use of any dangerous weapon or object c. Physical or sexual assault; physical, sexual or emotional intimidation of another person, including: i. Bullying: an intentional, persistent and repeated pattern of committing or willfully tolerating physical and non-­‐physical behaviors that are intended to or have the potential to cause fear, harm, or humiliation ii. Harrassment: a repeated pattern of physical and/or non-­‐physical behaviors that are intended to cause fear, humiliation, degradation or create a hostile environment iii. Hazing: coercing, requiring, forcing or willfully tolerating any humiliating, unwelcome or dangerous activity that serves as a condition for joining a group or being socially accepted by a group’s members iv. Emotional Misconduct, including verbal or physical acts, or online activity v. Physical Misconduct, including contact or non-­‐contact conduct vi. Sexual Misconduct, including sexual assault, sexual harassment, sexual abuse, or any other sexual intimacies (including online activity) that exploit or threaten an individual d. Use, consumption, buying, selling or giving away of alcohol, drugs (including prescription drugs for other than their intended purpose by the patient) e. Theft, including improper possession of equipment belonging to the Pocock Rowing Center, an adult, a teammate or member of another team f. Destruction or defacing of property g. Immoral or disruptive conduct, including disobedience of reasonable instructions of crew authorities 11. I understand that any individual’s failure to abide by these rules can jeopardize the entire group’s participation. I understand this code of conduct and I understand that failure to abide by its rules may result in disciplinary action, including
suspension or expulsion from participation in practices and regattas.
Printed Name of Participant:
Participant’s Signature:
Printed Name of Parent (if participant is under 18):
Parent’s Signature (if participant is under 18):
Date:
MEDICAL RELEASE AND TEMPORARY SURROGATE Note: This form must be signed in the presence of a notary public and returned to the Pocock Rowing Center. As the legal guardian of _____________________________________________________, I authorize the staff of the Pocock Rowing Center (PRC) or the George Pocock Rowing Foundation (GPRF) to act on my behalf in approving any all medical, dental, and surgical examinations or operations and treatment or all other related care, including the administration of drugs, tests, anesthesia and/or blood transfusions to the above named minor person that may be ordered by a physician and/or dentist in attendance at the medical center deemed necessary for emergency treatment during planned events or team travel. I hereby consent to the release of medical report(s) to any doctor or agency and consent to the admission of the above named minor person to the hospital. I understand that the Pocock Rowing Center, the George Pocock Rowing Foundation, and their officers, employees, and volunteers assume no financial obligation or liability in the case of my child’s accident or illness. If I, or anyone on my or my child’s behalf makes a claim against the Pocock Rowing Center, the George Pocock Rowing Foundation, or their officers, employees, and volunteers arising out of or related to my child’s participation in Pocock Rowing Centers programs, I agree to indemnify and save and hold them harmless from any litigation expenses, attorneys’ fees, loss, liability, damage, or costs they may incur due to the claim made against any of them, whether the claim is based on their negligence or otherwise. I sign this agreement on my behalf and on behalf of my personal representatives, assigns, heirs, and next-­‐of-­‐kin. I hereby give permission for emergency treatment for my child and assume financial responsibility for such treatment. In consideration of my child participating in this sport, including practices, regattas and the long-­‐distance travel to the Brentwood Regatta at the Brentwood College School April 24-­‐26, 2015 and long-­‐distance travel to USRowing Junior Regionals in Vancouver, Washington May 14-­‐17, 2015, I do hereby waive, release and forever discharge any and all rights and claims for damages against the Pocock Rowing Center (PRC), the George Pocock Rowing Foundation (GPRF), and any staff members or their representative successors for any damages sustained or suffered by this child in connection with his/her travel or program participation, except in cases of gross negligence. I have completed the Medical Information Form thoroughly, noting any medical requirements or restrictions pertaining to my child. I have informed and received approval for this authorization for all other legal guardians of my child. Name (Please Print) _________________________________________ Work Phone ____________________________ Address _______________________________________________________ Cell Phone ______________________________ Signature ______________________________________________________ Date _________________________ THIS FORM MUST B E SIGNED IN THE PRESENCE OF A STATE OF WASHINGTON NOTARY PUBLIC State of Washington ) ) ss. I certify that I know or have satisfactory evidence that ___________________________________________ signed this instrument, on oath County of King ) stated that he/she was authorized to execute this instrument, and acknowledge it to be the free and voluntary act of said party for the uses and purposes mentioned in this instrument. _________________________________________________________________ _______________________________________________________________ Signature of Notary Public Notary Public in and for the State of Washington ________________________________________________________________ Residing at _______________________________________ Printed Name My appointment expires _________________________________ JUNIOR MEDICAL HISTORY and RELEASE As the legal guardian of _____________________________________________________, I authorize the staff of the Pocock Rowing Center (PRC) or the George Pocock Rowing Foundation (GPRF) to act on my behalf in approving any all medical, dental, and surgical examinations or operations and treatment or all other related care, including the administration of drugs, tests, anesthesia and/or blood transfusions to the above named minor person that may be ordered by a physician and/or dentist in attendance at the medical center deemed necessary for emergency treatment during planned events or team travel. I hereby consent to the release of medical report(s) to any doctor or agency and consent to the admission of the above named minor person to the hospital. Parent/Guardian Sign Here: ___________________________________________ I understand that the Pocock Rowing Center, the George Pocock Rowing Foundation, and their officers, employees, and volunteers assume no financial obligation or liability in the case of my child’s accident or illness. If I, or anyone on my or my child’s behalf makes a claim against the Pocock Rowing Center, the George Pocock Rowing Foundation, or their officers, employees, and volunteers arising out of or related to my child’s participation in Pocock Rowing Centers programs, I agree to indemnify and save and hold them harmless from any litigation expenses, attorneys’ fees, loss, liability, damage, or costs they may incur due to the claim made against any of them, whether the claim is based on their negligence or otherwise. I sign this agreement on my behalf and on behalf of my personal representatives, assigns, heirs, and next-­‐of-­‐kin. I hereby give permission for emergency treatment for my child and assume financial responsibility for such treatment. Parent/Guardian Sign Here: ___________________________________________ Date _________________________________ Printed Name ___________________________________________________________ Relationship ________________________ First Person to contact in case of emergency: Name _______________________________________________________________ Phone _________________________________________ Second Person to contact in case of emergency: Name _______________________________________________________________ Phone _________________________________________ Physician ______________________________________________________Physician Phone _________________________________________ Asthma (circle) YES NO Does the child carry an inhaler (circle) YES NO MEDICAL CONCERNS: ________________________________________________________________________________________ Known Allergies: ______________________________________________________________________________________________ Other Medical Issues or Concerns: ___________________________________________________________________________ __________________________________________________________________________________________________________________ Junior Program Float Test All prospective rowing participants must pass a Swim / Float test prior to using any equipment provided by the Pocock Rowing Center or participating in any Pocock Rowing Center programs. This test can be administered by any certified Lifeguard or Water Safety Instructor at your local pool. This test is valid for 3 years. The Swim / Float test consists of keeping afloat for ten minutes without touching the sides or bottom of the pool, and without receiving assistance of any kind from an object or another person. You must also be wearing long pants and a long sleeve shirt while undergoing this test. Information below to be filled out by a certified Lifeguard / Water Safety Instructor only I, ________________________________________________________. a certified lifeguard / water safety instructor at the __________________ pool do hereby certify that _____________________________________ remained afloat under his/her own power for ten minutes without touching the sides or bottom of the pool, and without receiving assistance of any kind from any object or person. Date: ______________ Signature: _________________________________________________ LOCAL REGATTA WAIVER: USROWING 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 12/31/14 – 12/31/15, 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 W AIVER WITHOUT PRIOR APPROV AL FROM USROWING
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.
Printed Name of Participant:
USRowing #
Date of Birth: ________
Address:____________________________________________City:______________________________
State:
_ Zip: _____________Phone: ___________________________Date: ____________
Participant’s Signature: _________________________
Organization: POCOCK ROWING CENTER
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 , SA VE, 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.
Printed Name of Parent/Guardian: _______________________________________
Address: __________________________ City ____________________State ______ Zip __________
Phone: ___________________________Date: _________________
Parent/Guardian Signature (only if participant is under the age of 18): ___________________________________