NORTHVIEW SOCCER CAMP

MINOR GENERAL RELEASE AND HOLD HARMLESS AGREEMENT
I am the parent or legal guardian of the “minor”, who desires to participate in the
Northview Soccer Camp (hereinafter collectively referred to as the “Activities”)
operated or sponsored by Northview Community Church (hereinafter referred to
as the “Church”). I understand and acknowledge that the Church will not allow
the minor to participate in the Activities without releasing and holding the Church
harmless from any liability arising out of the minor’s participation in the Activities.
I have investigated the risks involved in the minor’s participation in the Activities
and fully understand and assume such risks on his or her behalf. Specifically, I
understand and acknowledge that the minor may suffer or experience, among
other things, personal injury or bodily damage, medical disabilities, loss or theft
of personal property, imprisonment, abduction and even death. I request that
the church allow the minor to participate in the activities, and in consideration
thereof agree hereby to release and forever discharge the church, its officers
and directors, and its employees, agents, and any parties volunteering on behalf
of the church, from all actions causes of action, injuries, claims, damages, costs
or expenses of any kind growing out of or related to any such activities in which
the minor participates. I understand that this is a full and complete release of all
injuries and damages which I or the minor may sustain as a result of his or her
participation in any activities, regardless of the specific cause thereof. I further
acknowledge and agree that I have given my consent for the minor to remain in
the custody of the Church’s representatives while participating in the Activities.
This Agreement is binding on the minor’s heirs, successors, and personal
representatives.
NORTHVIEW
SOCCER
CAMP
- JULY 13 - 17, 2015 -
VIDEO/STILL PHOTOGRAPHY AUTHORIZATION
I hereby authorize staff of Athletes in Action, Northview Community Church or
Abbotsford Food Bank to take video and still photos of my child during camp. These
videos and still pictures may be used on website and marketing materials as well
as youtube and facebook promotions. I understand they retain the sole right to use
photos and video for publicity and advertising purposes only.
MEDICAL TREATMENT AUTHORIZATION & POWER OF ATTORNEY
In the event the minor suffers an injury or condition during his or her participation
in the Activities, including transportation to and from the Activity, which may
endanger his or her life, cause disfigurement, physical impairment, or undue
discomfort if medical treatment is delayed, and reasonable attempts to contact
me and my spouse have been unsuccessful, I hereby appoint a Northview and or
Athletes in Action Representative, to make an informed decision regarding such
treatment, I hereby appoint the Northview and or Athletes in Action Representative
as my agent to act for me and in my name (in any way I could act in person) to
make any and all decisions for the minor concerning his or her personal care,
medical treatment, hospitalization and health care. This power of attorney and
delegation of authority shall terminate when the agent is first able to contact me or
my spouse. This information is for the sole use of Northview Community Church.
I hereby give permission for the child named on this registration to participate in the
Northview Soccer Camp. I have read and understood the legal information on this
page.
____________________________________________
Signature of Parent/Guardian – Date
CONTACT: Northview Community Church: Carrie at [email protected]
OR Abbotsford Food Bank: Brad at [email protected]
IN PARTNERSHIP WITH:
Become a total athlete! AIA’s university, college and club soccer players
will help your child develop fundamental dribbling, shooting, passing
and ball control skills. Each day includes exciting competitions and fun
tournaments. Every camper gets the individual attention they need to
grow physically, socially, mentally and spiritually.
WHAT TO BRING:
• 2 Water Bottles (freeze one ahead of time)
• Shorts and T-shirt (no jeans please)
• Cleats (not mandatory)
• Sweater/jacket/rain gear
• Sunscreen
• Hat
**PLEASE NOTE:
Lunch will be provided for all
campers, however, we
are unable to accommodate
dietary restrictions. If necessary
please send your child with a bag
lunch and drop it off at the
Hospitality Tent.
SCHEDULE:
9:00 Introduction
9:10 Warm Up
9:25 Group Game
9:45 BREAK
10:00 Fast Footwork
10:25 Skill Stations
11:30 Coach’s Corner
12:00 LUNCH Included**
1:00 Juggling
1:20 Euro Cup
1:45 BREAK
2:00 World Cup
2:45 Wrap Up
3:00 Home Time
32040 Downes Road
Abbotsford, BC V4X 1X5
(604) 853-2931
"– – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – –
LOCATION: Ridgeview Park, Vantage Place, Abbotsford
DATE: July 13-17, 2015
TIME: 9 AM to 3 PM
AGES: 6 to 14
PRICE: $125 ($115 Before June 1, 2015)
*$25 non-refundable cancellation fee if cancelled after June 14, 2015
NORTHVIEW SOCCER CAMP REGISTRATION FORM
Please fill out this form, detach and return it to Northview or the Abbotsford Food Bank,
along with your registration fee by June 1, 2015, to reserve your spot! Cheques payable
to Northview Community Church.
REGISTRATION: FOOD BANK CLIENTS PLEASE CONTACT BRAD at
604-859-5749 or by email [email protected]
$115.00 per camper $125.00 if registering after Monday, June 1, 2015.
Child’s Name (first and last):______________________________________________________ Age: ________
Address: ________________________________________________________________________________________________
Postal Code_________________________
o Male o Female
Birthdate:_____________________
T-shirt size(circle one): YS YM YL S M L Current School: ______________________
Parent/Guardian Name(s): _____________________________________________
Phone Number: ______________________Email Address: ________________________
Emergency Contact (Name): ________________________________________________
Emergency Contact (Phone #): _____________________________________________________________________
Child’s Care Card Number: __________________________________________________________________________
Does your child have any allergies or dietary restrictions? _______________________
___________________________________________________________________
Please list any medications currently being used: _______________________________________________
Does your child have a designated disability or delay?
Yes
No
Does your child qualify to receive one on one assistance at school? Yes
No
Has your child experienced: Seizures, Neck Problems, Back Problems, Fainting Spells,
Heart Problems, Nose Bleeds or Asthma? _____________________________________
Has your child experienced in the last year: Head Injury, Major Surgery, Overuse Injury,
Fractures? ______________________________________________________________
Other important information we should know about your child:_______________________
_______________________________________________________________________
Pick up authorization (other than Guardian) Name:______________________________
Will your child have transportation to and from camp? ____________________________
Amount Paid ______________________ Method of Payment _____________________