Amateur Athletic Waiver and Release of Liability In Consideration of being allowed to participate in any way in Kenai Peninsula Youth Foundation programs, the undersigned acknowledges, appreciates, and agrees that: The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releases or others, and assume full responsibility for my participation; and, I willingly agree to comply with the stated and customary terms and conditions for participation. If however I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and, I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release and hold harmless Kenai Peninsula Youth Foundation and the City of Kenai, their offices, officials, agents and / or employees, their participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessees of premises used to conduct the event (“Releases”), with respect to any and all injury, disability, death, or loss or damage to person or property, whether arising from the negligence of the releases or otherwise. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. PROGRAM COMPONENTS On-Ice Training — Players participating in the Beginner Hockey Camp will receive daily intensive on-ice skill training aimed at improving overall tactical and technical skills. Morning ice sessions will include technical training in the areas of skating and edge control, passing, shooting and stick handling, while afternoon sessions will focus primarily on offensive and defensive tactical play, small area games and scrimmages. Off-Ice Training — Each day, campers will participate in a variety of off-ice training techniques aimed at improving overall balance, agility, coordination and sport specific techniques (shooting, stick handling, skating -stride, etc.) General Fitness Training — In working to develop general levels of fitness and a strong athletic base, participants in the KRBB Summer Hockey Camps will be introduced to proper lifestyle choices such as nutrition, hydration, and sleep cycles and they will participate in non-hockey related activities to enhance their overall athleticism. X __________________________ Date Signed:____________ Participant’s Name (Please Print) FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT TIME OF REGISTRATION) This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all Releases, and for myself, my heirs, assigns, and next of kin, I release participation in these programs as provided above, even if arising from their negligence. X ______________________ Date Signed: _______________ Emergency Contact : ____________________________________ Phone:_____________________________ Kenai River Brown Bears PO BOX 2613 Kenai, AK 99611 Phone: (907)-420-7004 Email: [email protected] The Kenai Peninsula Youth Foundation Proudly Presents OUR PROGRAM Geoffrey Beauparlant Director Geoff is entering his 3rd season with the Brown Bears, and 6th in the NAHL. A graduate of Penn State University and Southern New Hampshire University, Geoff has spent the past 11 seasons coaching and developing professional, junior, and youth hockey players. Through his continuing effort to enhance local hockey programs, the Brown Bears are now offering local players an exciting opportunity to train with some of their favorite players and coaches. CAMP STAFF Zack Zulkanycz—Instructor Zack has come up through the Kenai Ice Hawks program and is a graduate of Kenai Central High School. He has played 4 years of junior hockey in the NAHL (Kenai River) and USHL (Dubuque). 2015 Registration Form CAMP OVERVIEW The Kenai River Brown Bears Summer Hockey Camps was developed by professional coaches with the aim of providing a fun and supportive environment for youth players to increase their skills and knowledge of the game. All activities have been specifically designed to allow athletes to maximize their skill development while increasing their overall fun and enjoyment of the sport. Name:___________________________________ DOB:___________ Address:__________________________________________________ City/State: ____________________________________Zip:_________ Current Team:____________________ Level of Play:______________ Parents’/Guardians’:_________________________________________ Email:____________________________________________________ *All communication will be sent via email* 2015 Summer Program Fees SAMPLE DAILY SCHEDULE EVENT START END Player Drop Off 8:00 am 8:15 am Dynamic Warm Up 8:15 am 8:45 am Ice Session # 1 9:00am 10:00 am Snack 10:15 am 10:30 am Off-Ice Training 10:45 am 11:45am Lunch * 12:00 pm 1:00 pm Ice Session # 2 1:30 pm 2:45pm Off-Ice Training # 2 3:00 pm 4:00 pm Dismissal 4:00 pm — All training held at the Kenai Ice Rink All players must have current USA Hockey Registration Number Summer Hockey Camps $250 Includes 5 full days of on and off ice training and instruction and lunch provided. Summer Hockey Camps $200 Includes 5 full days of on and off ice training and instruction. Week 1 - July 6-10 or Week 2 - July 13-17 Registration Policy Please mail registration form with signed waiver to address on back cover of the brochure. *Please make checks payable to Kenai River Brown Bears. A $25 service fee will apply for any checks returned. Registration Deadline Deadline for the High School Hockey Camp is: 6/15/15 * Please see pricing programs *A 50% non-refundable deposit is due at the time of registration. Payment Plans are available upon request. Payment Information Tanner Schachle—Instructor Tanner is a native of Wasilla, AK and is entering his 2nd season as a member of the Brown Bears. He was listed as an NHL “Player to Watch” during the 2014-15 season. If paying by credit card, please complete the following information. A 3% convenience fee will be charged to your account. Card Type: Visa Master Card Card #:______________________________ Name on Card:________________________________________________ Mailing Address:_______________________________________________ Exp. Date:______________Signature:______________________________ Colton Fletcher—Instructor Colton is also from Wasilla, AK and entering his 2nd season with the Brown Bears. He was drafted by the Bears (along with Schachle) in the 2nd round of the 2014 NAHL Draft Refund Policy If in the unlikely event Kenai Peninsula Youth Foundation cancels an event, every effort will be made to re-schedule the cancelled event. If the event cannot be rescheduled, the athlete will be reimbursed the cost of the session. I have read, understood, and accept the above policies for Kenai River Brown Bears: Signature____________________________________________________Date_______________
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