wildcats/newscaptions/baseball camp form.pdf
CARLISLE WILDCAT BASEBALL CAMP
MONDAY, MARCH 15 – TUESDAY, MARCH 16
3RD - 4TH GRADE: 4:30 – 6:30
5TH – 6TH GRADE: 7:00 – 9:00
ALL CAMPERS MEET IN THE ELEMENTARY REC CENTER
CLINICIANS: Carlisle coaches Dave Dirkx, Chris Miller, Jared Fletcher
Players need to bring glove, bat (Tuesday), and wear appropriate clothing
Monday – throwing, infield, outfield; Tuesday – pitching, catching, offensive skills
COST: $35, Campers will receive a T-shirt
Make checks payable to: Dave Dirkx
Send entry form and waiver by February 26 to:
Carlisle Community Schools
ATTN: Dave Dirkx
430 School Street
Carlisle, IA 50047
Entry forms may also be dropped off at the High School Office
CUT OFF AND RETURN THE BOTTOM PORTION
ENTRY FORM AND RELEASE
NAME: ___________________________ GRADE: _______ T-SHIRT SIZE: _________
NAME: ___________________________ GRADE: _______ T-SHIRT SIZE: _________
RELEASE:
The undersigned hereby agree to release Dave Dirkx, all assistant coaches, trainers, Carlisle School District personnel, and their representatives, agents, servants and employees from liability for any injury to the student(s) named above, resulting from any cause whatsoever occurring to the named person at any time while attending the Carlisle Baseball Camp, including travel to and from the camp.
Further, I do voluntarily authorize Dave Dirkx, all assistant coaches, trainers, Carlisle School District personnel, and their representatives, agents, servants and employees assistants to obtain routine or emergency medical treatment for the named person as deemed necessary by Dave Dirkx. As parent/guardians of camp participant(s) I expressly authorize emergency medical treatment to be administered as needed. Any further treatment will require parental/guardian consultation.
I agree to indemnify and hold harmless Dave Dirkx, all assistant coaches, trainers, Carlisle School District personnel, and their representatives, agents, servants and employees for any and all claims, demands, actions, rights of action, and/or judgments flowing from said procedures and/or treatment rendered in good faith and according to reasonable and prudent medical standards.
Date: _____________ Parent/Guardian Signature: _____________________________________
Address: ____________________________________________ Phone(s): _____________________
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