MEN`S SOCCER COLLEGE PREP CAMP

IINDEMNIFICATION AGREEMENT
WAIVER AND RELEASE OF ALL CLAIMS
PERMISSION TO SECURE TREATMENT
Loras College Soccer Prep Camp--July 23, 2016
ABOUT LORAS COLLEGE
Please read this form carefully and be aware that by participating in the
Loras College Soccer Prep Camp on July 23, 2016 (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.
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.
Integrating service into its culture, Loras has
been appointed to the President’s Honor Roll
for Service with Distinction every year, and
received the first President’s Award for Interfaith
Community Service in 2014. With nearly 40
majors and 13 pre- professional areas of study to
choose from, the academic, cultural, spiritual and
athletic experiences at Loras offer students wide
opportunities to pursue their passions and create
successful, rewarding careers and lives.
Ranked 13th Best College among Midwest
regional colleges by US News Media Group
for ensuring academic rigor, and #6 Best Value,
Loras consistently outperforms peer institutions
in employment after graduation, with nearly
96% of graduates reporting being employed or
continuing their education within twelve months
of graduation.
Participant Name(s) :___________________________________________
(Parent)
(Child)
Address: ____________________________________________________
COLLEGE PREP CAMP
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..
2015 NATIONAL
RUNNER-UP
1450 Alta Vista Street | Dubuque, IA 52001-4327
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.
Loras College, as a Catholic, liberal arts college,
creates a community of active learners, reflective
thinkers, ethical decision-makers and responsible
contributors in diverse professional, social and
religious roles. Founded in 1839, Loras leverages
its historic roots as Iowa’s first college and its
position as one of only ten diocesan colleges in
the nation, to deliver challenging, life changing
experiences that make it the perfect place to
prepare for a life you’ll love.
BE MORE. BE LORAS.
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.
MEN’S SOCCER
COLLEGE PREP CAMP
SATURDAY, JULY 23, 2016
Our Mission: To be the best small college in
the country to play soccer.
Participant Signature(s): ________________________________________
________________________________________
(Must be signed by Parent or Guardian if any Participant is a minor)
Relationship to Participant (if Participant is a minor):__________________
BE MORE. BE LORAS.
1450 Alta Vista Street | Dubuque, IA 52001-4327 | 800-245-6727
DUHAWKS.COM
SOCCER COLLEGE PREP CAMP
Dan Rothert
Camp Director and Head Men’s Soccer
Coach at Loras College
[email protected]
(563) 588-4936
The College Prep camp is designed to expose
campers to training and competition that they will
find at the college level. Coach Rothert and his
staff of Loras College coaches, assisted by current
Duhawk soccer players, will run training sessions
just like those that have helped the Loras men’s
program become one of the nation’s elite college
soccer programs.
Campers will also
be provided plenty
of opportunities to
compete each day so
they can demonstrate
what they have
learned.
The camp is open to
soccer players 15 years
of age or older, but is
primarily intended for
those entering their junior and senior year of high
school. The camp will take place at Loras, include
an overnight stay and meals provided by Loras’
dining service. Goalkeepers will receive specialized
training. Each camp has a limited number of
openings, so get your registration in early.
MEALS
Loras College Campus Dining will serve lunch and
dinner in the Café.
REGISTRATION
To register for the camp, fill out the Registration
form and the Waiver and Release form (on back)
and return to the address indicated along with a
check for $100 payable to Loras Soccer Camp.
After registering for the camp, you will receive a
confirmation email including directions to where
registration will be the first day of the camp.
REGISTRATION DEADLINE - July 15, 2016
CHECK-IN
Check in is 9:30 a.m. with lunch at noon. Camp
will end at approximately 8:00 p.m.
CAMP DIRECTORS:
DAN ROTHERT (’96)
LORAS COLLEGE SOCCER
ACCOMPLISHMENTS
MEN
• 2015 National Runner-up
• NCAA Final Four: 2007, 2008, 2012, 2013,
2015
• 9 Consecutive Top-20 Final Rankings
• 10 IIAC Championships
• 11 Consecutive NCAA Tournaments
Appearances
WOMEN
• 9 IIAC Championships
• 11 IIAC Tournament Titles
•11 NCAA Tournament Appearances
•
•
•
•
•
•
•
•
MATT PUCCI (’08)
LORAS COLLEGE
ATHLETIC FACILITIES
• Rock Bowl Stadium—home to Loras Soccer,
features an all-weather turf surface and lights.
• Athletic and Wellness Center—includes a
basketball/volleyball arena, two-level fitness
center/weight room, locker rooms, coaches’
offices and athletic training room.
• Graber Sports Center and San Jose Pool
• Faber-Clark Field—Loras practice field
• Loras College Fieldhouse
• Loras College Head Men’s Soccer Coach and Director of Soccer
• 2012 National Coach of the Year
• USSF “A” License
NSCAA Premier License
National Goalkeeping Diploma
National Youth License
14-time IIAC Coach of the Year
3-time Regional Coach of the Year
Overall Record at Loras: 533-178-44
19 IIAC Championships
22 NCAA Tournament Appearances
(including 12 Sweet 16s and 5 Final Fours)
•
• Men’s Associate Head Coach, Men’s Recruiting Coordinator since 2010
• 2004-2007 All-Region student-
athlete at Loras
• 2008-2009 Asst. coach at
Misirecordia Univ. (Pa.) (two NCAA
Tournament appearances)
Led Wahlert Catholic HS to State
Championship as head coach in 2008
REGISTRATION
Registrations accepted via credit card at www.
lorassoccer.com.
PLAYER REGISTRATION FORM
LORAS SOCCER COLLEGE PREP CAMP
Online registration available at
www.lorassoccer.com
PLEASE PRINT LEGIBLY
Player Name:_________________________________
Address:______________________________________
City:________________________________________
State: __________ Zip:________________________
Home Phone:_________________________________
Cell Phone:__________________________________
Player Email Address:__________________________
Parent/Guardian:______________________________
High School:_________________________________
H.S. Graduation Date: ____________________
Position(s):___________________________________
Club Team: __________________________________
Club Coach Name:____________________________
Club Coach Phone #:___________________________
H.S. Coach Name:_____________________________
H.S. Coach Phone #:___________________________
Current GPA: ____________
ACT: ____________
Intended Major:_______________________________
Soccer Honors:_______________________________
________________________________________
________________________________________
T-Shirt Size (circle one):
S
M
L
XL
Please fill out this form on both sides and return
by July 15, 2016, with a check for $100
(payable to Loras Soccer Camp) to:
LORAS SOCCER - COLLEGE PREP CAMP
c/o Dan Rothert, Head Soccer Coach
Loras College Mail #149
1450 Alta Vista Street
Dubuque, IA 52001-4327
– No refunds –