Youth Program Registration Documents 2014-‐2015 Welcome to a new year of Rowing at ETRO! Greetings athletes and parents! We hope everyone had a great summer break, but now it is time to begin working hard and rowing fast! ETRO is implementing a new “electronic” registration process this year in order to reduce environmental waste and simplify/secure our document storage responsibilities. Please complete the online registration process and payment arrangements and print copies of necessary non-‐ electronic forms to be completed and submitted. We have made our best effort to structure the fee schedule in accordance with the data from prior years and current estimates of our budget expenses for the fiscal year 2014-‐2015. •
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All Parents, Guardians and Rowers must complete the required forms included in this registration packet. All documents and payment arrangements must be submitted before a rower will be allowed to participate in Scrimmages or Regattas. Billing/payment inquiries and other related questions should be directed to: • Andrew Krug-‐ Head Coach/Program Director – 865-‐850-‐4649 or [email protected] • Jeffrey Coy – Executive Director/Assistant Coach -‐ 256-‐289-‐3359 or [email protected] Forms and documents: 1.
ETRO Event Planning Guide 2.
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Fees and Payment Form All Parents & Rowers must provide preliminary registration at http://igetrowing.com 4.
Consent to Participate Form -‐ Required every year at ETRO 5.
TSSAA Pre-‐participation Physical Evaluation – Required by the School System – we will require this form, Spring 2015 Season, for new athletes. http://maryville.schoolwires.net/cms/lib07/TN01916237/Centricity/Domain/426/TSSAA%20Preparticipation%20Form.pdf 6.
Medical History Questionnaire and Authorization to Treat Form -‐ Required every year at ETRO 7.
Parental Consent Release and Waiver of Liability -‐ Required every year at ETRO 8.
Swim Test Form – Required once in a ETRO Athletes Career 9.
Media Release -‐ Required once in a ETRO Athletes Career 10.
Carpool Release -‐ Required once in a ETRO Athletes Career 11.
Athlete Code of Conduct Form -‐ Required every year at ETRO 12.
ETRO Scholarship Application – Required as needed 13.
US Rowing liability waiver 2014 -‐ Required once in a ETRO Athletes Career a. If not already registered, please register at the Regatta Central website: 1. https://www.regattacentral.com/athletes/ 2. Be sure to use the ETRO roster code DF-‐993650 when registering Youth Program Registration Documents 2014-‐2015 ETRO Event Planning Guide Fall 2014 / Winter Training / Spring 2015 This form is used to help you in planning for the upcoming seasons. If your child will need transportation a local Regatta requiring Car-‐pooling, a “carpool sign up” will be sent out prior to each regatta. For more specific information please see our Fall Season Calendar on the “Youth Tab” of the web site. Fall Programming 2014 -‐ Competitive Programming Travel & Fitness/Development Scrimmage
Event Date & Location Transportation type 1. ETRO Local Scrimmage 27 September 2014 -‐ ETRO Boathouse Local 2. Chattanooga Head Race 11 October 2014 -‐ Chattanooga, TN Charter Bus -‐ no Hotel 3. Secret City Head Race 25 October 2014 -‐ Oak Ridge, TN Local -‐ Car Pool 4. Head of the Hooch
1-‐2 November 2014 -‐ Chattanooga, TN Charter Bus -‐ Hotel 5. Fitness /Dev. Program 8 November – ETRO Boathouse Local
Scrimmage 6. Fall Season Banquet 22 November -‐ Location TBD Local Youth – Semi Formal Winter Training -‐ January 2015 -‐ TBD -‐ Competitive Programming & TBD Fitness/Development
1. TN Indoor Championships 31 January 2015 -‐ Chattanooga, TN Charter Bus -‐ no Hotel Spring Programming 2015 -‐ Competitive Programming Travel & Fitness/Development Scrimmage 2. ETRO – Erg-‐ A-‐ Thon 14 February 2015 – Maryville, TN Local 3. Scrimmage – TBD 07 March 2015 -‐ Nashville, TN Charter Bus -‐ no Hotel 4. John Hunter Regatta -‐TBD 28 March 2015 – Lake Lanier, GA Charter Bus -‐ Hotel 5. Lake Lanier Sprints 29 March 2015 – Lake Lanier, GA Charter Bus -‐ Hotel 6. Clemson Sprints -‐TBD 11 April 2015 -‐ Clemson, SC Charter Bus -‐ no Hotel 7. Dogwood Regatta 25 April 2015 -‐ Oak Ridge, TN Car pool-‐ Local 8. Southeast Regional Championships – TBD 9. End of Season Party -‐ TBD 10. US Rowing –Youth National championships – TBD (not included in program pricing)
Youth Program Registration Documents 2014-‐2015 ETRO 2014-‐2015 Fall-‐Winter-‐Spring Fee Schedule NEW ROWERS HAVE A 2-‐WEEK FREE TRIAL PERIOD: *During this period only the “Consent to participate” and “US Rowing Waiver” need to be completed. FEES INCLUDE: (but are not limited to) US Rowing Organizational an Basic individual membership, Charter Bus travel to selected Regattas, Athlete Hotel Rooms, Regatta Entry Fees, Equipment expense, Coaching expenses, Truck & Trailer Expenses, Meals/Snacks @ Team Tent, Watt Street CrossFit Training, Year end banquets/awards; as well as, other costs associated with all programs. *Fees do not include -‐ returning rower uniform or ETRO spirit wear, carpool required regatta travel, dinner and breakfast for overnight regattas (unless hotel provided), acquisition of new equipment, Special Regattas-‐ Head of Charles/ Nationals/Henley or summer programming. VOLUNTEER HOURS: Each parent/family is asked to volunteer 10 hours of your time. Opportunities to serve include Charter Bus Chaperone, Hotel Chaperone, Team Food Tent assistance, Boathouse assistance, etc. Please check the ETRO website to find a complete list of volunteer positions, we cannot do this... without YOU! *Our Youth Team Parent Coordinator is: Kim Krawczyk SCHOLARSHIP ASSISTANCE: Our desire is that all athletes who chose to join our program are able to do so. We offer limited financial assistance to families in need. Please make sure if your family needs assistance to ask for it. ETRO’s mission is to ensure that “everyone rows”. The scholarship assistance form is at the end of this document. REGISTRATION & FACILITIES FEE: We have implemented a yearly fee to assist in covering ever-‐increasing cost associated with our operations: these include liability insurance, online presence and fee processing. *First year Race Team athletes will receive a “Uni-‐suit” included in registration *Fitness/Development program athletes will receive a “ETRO Race Top” included in registration. Registration & Facilities Fee: (once per year) •
$95.00 Option 1: Competitive Race Team -‐ Varsity or Novice competitive travel squads -‐ 10 Months-‐3 seasons * See “Event Planning Guide” for events included * 5% discount from seasonal rates-‐ Fall $825, Winter $175, Spring $950 = $1950.00 •
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$1850.00 full payment due September 1, 2014 $185 monthly for 10 months beginning September 1, 2014 Coxswain $1500.00 full payment due September 1, 2014 $150 monthly for 10 months beginning September 1, 2014 Option 2: Competitive Race Team -‐ Varsity or Novice competitive travel squads -‐ Fall 2014 season only * See “Event Planning Guide” for events included •
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$825 full payment due September 1, 2014 $275 monthly for 3 months beginning September 1, 2014 Coxswain $475.00 full payment due September 1, 2014 (discounted rate) $158 monthly for 3 months beginning September 1, 2014 Option 3: Fitness/Development Team -‐ Experienced or Novice Non traveling squads – Fall 2014 season * See “Event Planning Guide” for events included * We must meet minimum participation numbers for this program to exist •
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$450 full payment due September 1, 2014 $150 in three monthly payments beginning September 1, 2014 Winter/Spring Season 2015 “only pricing” -‐ Winter $175, Spring $950 Payment: we are now processing payments online through the ETRO Website Ø Debit and Credit cards-‐ Full payment and recurring Ø Checks should be made to ETRO • Delivered to: Jeffrey Coy-‐ Watt Street CrossFit, 259 E. Watt ST. Alcoa, TN 37701 • Mailed to: ETRO, 250 E. Broadway St, Maryville, TN 37904. Ø Scholarships and special payment arrangements are available … “ everyone rows ” Youth Program Registration Documents 2014-‐2015 Consent to Participate Athlete Name: ____________________________________________________________________ Name of Parent/Guardian: ______________________________________________________ Parent/Guardian Email: _________________________________________________________ Address: ___________________________________________________________________________ _________________________________________________________________________ Phone: ____________________________________________________________________________ Emergency Contact: _____________________________________________________________ Date of Birth________________ I hereby grant permission for my child to participate in rowing activities as a 2014-‐2015 East Tennessee Rowing Organization member in association with Smoky Mountain Rowing Center. I acknowledge that my child is able to swim at least fifty yards and he or she has no physical or health condition that would prevent his or her participation in the sport of rowing. Rowing is an extremely safe sport and it is unlikely that any harm will come to any participant. However, I agree to hold harmless East Tennessee Rowing Organization and Smoky Mountain Rowing Center, its coaches or owners in the event of personal injury to my child during the course of any Club activity. I have read and signed the US Rowing Liability Waiver. Signed/Date ________________________________________________ / __________________ Youth Program Registration Documents 2014-‐2015 2014-‐2015 Medical History Questionnaire Instructions: This form must be completed by a parent/guardian and turned on the first week of practice. Athlete Name (first middle last) _____________________________________Birth Date_________________ YES NO 1. [ ] [ ] Are you currently under a doctor’s care? If so, who and why? 2. [ ] [ ] Do you take any medications daily or routinely? Please list below. 3. [ ] [ ] Allergic to any medications (aspirin, penicillin, etc.)? Please list below. 4. [ ] [ ] Allergic to any food or insect? 5. [ ] [ ] Any chronic or recurrent illnesses(diabetes, asthma, ulcer, bronchitis, sicklecell anemia)? 6. [ ] [ ] Any hospitalizations? 7. [ ] [ ] Any illnesses requiring bed rest of one week or longer? 8. [ ] [ ] Any surgery? 9. [ ] [ ] Any surgery advised and not taken? 10. [ ] [ ] Ever had any symptoms of heart problems? 11. [ ] [ ] Chest pains? 12. [ ] [ ] High blood pressure? 13. [ ] [ ] Close relative under 40 to die of heart disease? 14. [ ] [ ] Any dizziness, fainting, convulsions, or frequent headaches? 15. [ ] [ ] Ever been “knocked out” or had a concussion? 16. [ ] [ ] Wear eyeglasses or contact lenses? 17. [ ] [ ] Any serious eye injuries? 18. [ ] [ ] Wear any dental appliances (braces, retainer, bridge, plates)? 19. [ ] [ ] Ever suffered heat exhaustion or heat stroke? 20. [ ] [ ] Ever had mononucleosis? If so, month/year? 21. [ ] [ ] Any history of enlarged spleen or liver? 22. [ ] [ ] Any organ missing other than tonsils (appendix, eye, kidney, spleen)? 23. [ ] [ ] Any history of collapsed lung or tuberculosis? 24. [ ] [ ] Any knee injury? 25. [ ] [ ] Any ankle injury? 26. [ ] [ ] Any neck injury? 27. [ ] [ ] Any other joint sprains or dislocations (shoulder, wrist, finger)? 28. [ ] [ ] Any broken bones (fractures)? 29. [ ] [ ] Any communicable diseases? 30. [ ] [ ] Any known reason why this individual should not participate? Describe any “YES” answers in detail below or on the back of this sheet. Enter question number before comment. All statements answered in this record are true to the best of my knowledge. I have no abnormality, limitations, or restriction not mentioned in this record. I understand that this information is used to help determine my fitness to participate in athletics. Student’s Signature_____________________________________________Printed Name_____________________________Date_______________ Parent/Guardian Signature____________________________________Printed Name______________________________Date______________ Youth Program Registration Documents 2014-‐2015 2014-‐2015 Medical Emergency Authorization to Treat Instructions: Please print. It is recommended that a photocopy of the front and back of a health insurance card be attached to this form. This form must be turned in on the first day of practice. Athlete Name (first middle last) ___________________________________________________Birth Date_______________________________ Medical Insurance Company __________________________________________________________________________________________________ Phone Number ____________________________ Allergies _________________________________________________________________________________________________________________________ Medications taken daily or routinely__________________________________________________________________________________________ In case of an emergency, the parent/guardian primary contact should be: Name_________________________________________________Contact Number___________________________Relationship________________ Mother (first middle last) ______________________________________________________________________________________________________ Work Phone ________________________________Cell Phone____________________________Email______________________________________ Father (first middle last) _______________________________________________________________________________________________________ Work Phone _______________________________Cell Phone_____________________________Email______________________________________ I hereby give consent for the following local medical care providers and local hospital to be called for emergency treatment: Physician’s Name_______________________________ Phone Number_________________________________ Dentist’s Name__________________________________ Phone Number__________________________________ Local Hospital of Choice___________________________________________________Contact Number____________________________________ In the event that reasonable attempts to contact a parent/guardian have been unsuccessful, I hereby give my consent for: 1. The administration of any treatment deemed necessary by the above named physician or dentist, or in the event that the physician or dentist is not available, by another licensed physician or dentist. 2. The transfer of the athlete to any hospital reasonably accessible. I understand that this authorization does not cover major surgery unless the medical opinions of two licensed physicians or dentists concurring in the necessity for such surgery are obtained prior to the performance of such surgery. Signature of Parent/ Guardian___________________________________________________________Date_________________________________ Youth Program Registration Documents 2014-‐2015 Swim Test Instructions: 1. Write Name of Participant on the Swim Test Card 2. Have a certified Lifeguard/Water Safety Instructor observe you and complete form below 3. Make a copy of your card for your records 4. Bring this form to the boathouse on the first day of program; or mail a copy to: Executive Director -‐ETRO 250 East Broadway Maryville, TN 37804 Name of Participant/Rower: __________________________________________________________________________ Name of Lifeguard/Water Safety Instructor: ________________________________________________________ Name of Pool: __________________________________ Phone Number of Pool: _____________________________ Swim Test Certification -‐ I hereby certify that the participant can: Dressed in Rowing attire complete the following. 1. Swim 50 yards or meters in a competent manner 2. Remain afloat for at least 5 minutes. Signature of Lifeguard/Water Safety Instructor: ___________________________________________________ Date of Test: ____________________________ Keep a copy of the completed swim test for your records. Executive Director ETRO, Inc. 250 East Broadway Maryville, TN 37804 Email: [email protected] Phone 256-‐289-‐3359 Web: www.igetrowing.com Youth Program Registration Documents 2014-‐2015 Photo / Media Release Form I grant permission to the Smoky Mountain Rowing Center (SMRC), and its subsidiary clubs, to use photographs, video, audio recordings, and/or textual material created and/or distributed by or for SMRC that includes my name and/or image, including web sites or other electronic forms or media, and to offer the photographs, video, audio, or text for media or promotional use, without notifying me. I hereby waive any right to inspect or approve the photographs, publications, or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the photographs. I hereby agree to release and hold harmless SMRC, and its subsidiary clubs, from and against any claims, damages or liability arising from or related to the use of the photographs or other media, including but not limited to any re-‐use, distortion, blurring, alteration, optical illusion or use in composite form, either intentionally or otherwise, that may occur or be produced in production of the finished product. It is the discretion of SMRC to use the media. I have read this release before signing below, and I fully understand the contents, meaning and impact of this release. Athlete Name: ________________________________________________________________________________________ Name of Parent/Guardian: __________________________________________________________________________ Parent/Guardian Email: _____________________________________________________________________________ Signature Parent/Guardian:____________________________________________________Date:_______________ Youth Program Registration Documents 2014-‐2015 Carpool Release Assumption of Risk, Waiver of Claims and Indemnity Agreement Outside of Charter Bus leasing for the majority of our travel events, ETRO provides a sign up system whereby individuals interested in carpooling to local events may voluntarily do so. Parents are welcome to travel to all events in their own vehicles and frequently, parents may be asked to chaperone on the team Charter Bus. Users of this car pool sign up system are advised that its use is voluntary and entirely at their and their parent’s/guardian’s discretion. If parents/guardians do not wish to utilize the carpool sign up system for “non” Charter Bus travel events, it is their responsibility to get themselves and their rower to and from regattas. However, only athletes over 18 years of age are permitted to transport themselves or other athletes to ETRO events/regattas, with authorization of the other rowers Parents/Legal Guardians and this document. No background checks of drivers or participants, driver record checks or insurance checks are undertaken by ETRO. ETRO nor SMRC does not make any assurances or certifications regarding the condition, suitability or safety of the vehicles being used by participants, the reliability or driving ability of participants or drivers, or whether those participants and drivers are insured. Responsibility for Insurance It is the responsibility of individuals participating in a carpool to notify their insurance provider of their intent to carry non-‐family passengers and to ensure that they have adequate coverage to protect both themselves and their passengers. It is the responsibility of the driver of the vehicle to ensure they have an acceptable driving record, are licensed accordingly and have adequate insurance to protect both themselves and passengers. ETRO/SMRC is in no way responsible for verifying or certifying the reliability, driving ability or insurance status of drivers and participants. Waiver of Claims & Indemnification ETRO/SMRC takes no responsibility for any personal injuries, deaths, property damages, financial losses or other damages or losses that may result from the use of carpooling. By participating in the ETRO carpool sign up program, you hereby agree to waive any and all claims that you have or may have in the future against ETRO or SMRC and to release them from any and all liability for loss, damage, expense or injury including death that you, your next of kin or a third party may suffer as a result of your participation in or involvement in the ETRO program. You hereby also agree to indemnify and hold harmless ETRO/SMRC from any and all liability for personal injury, death, property damages and any other loss, and resulting claims or actions, arising from your participation in or involvement in the ETRO program. I have read and understand this “description of service, assumption of risk and waiver of claims and indemnity agreement”. ____________________________________________________________ ______________________________ Rower’s Name & Signature Date ____________________________________________________________ ______________________________ Parent Name & Signature Date Youth Program Registration Documents 2014-‐2015 YOUTH PROGRAM CODE OF CONDUCT East Tennessee Rowing Organization (ETRO) operates on the philosophy that all athletes (rowers and coxswains) have the right to learn the sport of rowing. To do so each athlete needs a climate that is satisfying, productive and not filled with disruptive behavior by other athletes. The welfare and safety of rowers, coxswains and coaches is of paramount concern. Rowers in particular have a tradition of excellence on and off the water. It is expected that participants will keep up this tradition, not only in rowing activities, but also in school. Each participant is encouraged to strive for excellence as an athlete and as a student. In order to be accepted into the program, personal discipline is required. This document presents guidelines for maintaining such an atmosphere during practice, regattas and other club sponsored events. This is an agreement between the athlete, their parents or guardians and the ETRO Youth Rowing Program, Smoky Mountain Rowing Center (SMRC) and Blount County School system. Athletes and parents/guardians are expected to abide by these rules and regulations that follow while on ETRO/SMRC property, while in attendance at all regattas or any club sponsored events. Parent/Guardian Role A parent/guardian and athlete are required to sign this Code of Conduct form attesting to the fact that they are aware of the rules and will abide by them. 1. Attendance and Punctuality Ø Rowing is a team sport – participants depend on each other. When a rower or coxswain does not come to practice it upsets the entire boat. Actions and in-‐actions affect everyone on the team… consider this and act accordingly. Ø Missing practice without notifying the Coach of a valid reason will be considered an unexcused absence. The Coach will consider individual circumstances and events to determine what denotes a valid reason. A. Excusable -‐ reasons for missing practice are: (must include communication with the Head Coach § Serious illness/injury § Academic or other obligations previously scheduled and communicated with the Head Coach § Religious holidays, Mission Work previously scheduled or committed to.
§ Family Emergencies B. Un-‐Excused -‐ reasons for missing practice § Non-‐ Emergency Medical appointments -‐ (Schedule around practice please) § Heavy course load/homework – (Develop disciplined study habits) § Family outings: Birthdays, Picnics, etc. § After school projects-‐ (What was the first commitment-‐Rowing or the project?) § Last minute practices called by Music and/or Theater Directors
§ Last minute study groups or exam reviews § Anything other than the items listed as excusable C. Punitive Measures: § Any rower with an un-‐excused absence from practice may or may not participate in practice upon his or her return -‐ discretion of the coach. § Rowers who have un-‐excused absences will risk jeopardizing their seat at practice and in regattas-‐ discretion of the coach. Youth Program Registration Documents 2014-‐2015 YOUTH PROGRAM CODE OF CONDUCT D. Other Items: § Athletes are committing to the team for each respective Season, not just convenient Regatta’s or practices, all fees are non refundable. § All crewmembers must race in ETRO uniforms, and observe ETRO Youth Program, Smoky Mountain Rowing Center policies, respective School and US Rowing Rules and Regulations. § Having a parent present at a team function does not supersede club rules and guidelines. § Athletes choosing to room with parents rather than their teammates on an overnight trip will have the same curfew as the rest of the athletes. § When traveling, ETRO Athletes must stay in the designated hotel at all times and follow instructions from the coaches or chaperones. § No boys will be permitted in girls’ rooms/no girls are permitted in the boys’ rooms unless supervised by a Coach or Chaperone. § Rowers are to travel with the team and are not permitted to drive themselves to regattas, unless carpooling with adult ( 18 year old) ETRO drivers or their parents. Car-‐pool Waiver needed. E. Controlled Substance § We have zero tolerance regarding the use of alcohol, tobacco or any illegal substances. These are strictly prohibited. F. Protection of Property § Rowers are not allowed in the boathouse or on the SMRC property unless supervised by a coach or an adult rower who is a member of ETRO/SMRC or has received permission fro SMRC/ETRO leadership or Coaches. § Rowers/Athletes are not allowed at the Watt Street CrossFit facility with out permission or supervision. § Respect for the equipment and the facility is mandatory. Please treat the boats with care. Broken equipment would keep us from practicing as well as being expensive to replace. Please let us know if you notice broken equipment so that we can repair it as soon as possible. Some repairs may incur costs on the rowers involved. § Individuals, as well as parents may be held financially responsible for any malicious/negligent damage to equipment, hotel rooms, etc. G. Appropriate Behavior § Cell phone use during practice is prohibited. Ringers are to be turned off. During practice phones are not to be on your person or in the boat. Phones can be left in vehicles or backpacks at the Boathouse. (SMRC/ETRO is not responsible for lost/stolen items) § Show respect to coaches, team members, and the other people who share the facility. Teammates and other members of the organization must be treated with courtesy and respect. Behavior that reflects poorly on ETRO will not be tolerated. § Hazing is prohibited. Physical, verbal, or sexual abuse either in person, print, or via electronic/social media will not be tolerated. All members covenant and agree not to discriminate against other members, race officials or competitors on the basis of the fact or perception of a person’s race, color, creed, religion, national origin, ancestry, height, weight (except as dictated by equipment limitations), age, sex, or sexual orientation. § Fighting will not be tolerated. § No weapons may be brought to team functions-‐Coaches Discretion (pocket knife) § Cursing and foul language will not be tolerated-‐ audibly or on visible social media. Youth Program Registration Documents 2014-‐2015 YOUTH PROGRAM CODE OF CONDUCT Appropriate Behavior-‐cont. Public display of affection (PDA) including but not limited to full frontal hugging, spooning, hand holding, and/or kissing is strictly prohibited. § Coaches, as well as, college admission offices and future employers, monitor social networking websites. Be mindful of the image you are projecting of yourself and your activities. Any inappropriate or illegal postings may lead to disciplinary action. § When traveling as a team, rowers must behave in a manner in a manner that reflects well on themselves, your family, your team, and ETRO/SMRC. § Race officials, regatta volunteers and other teams are to be addressed in a courteous manner. § During a race, the use of foul language by any member of the crew can result in disqualification of the boat by race officials/referees. § Any rower, who does not abide by these rules, may be placed under close adult/chaperone supervision and action may be taken to coordinate transport home at parent's/guardian's expense. Any individual's failure to abide by these rules can jeopardize the entire group's participation at that time and in the future. Disciplinary Actions Infractions upon these rules will lead to disciplinary action to be determined by the coaches, including, but not limited to: § Verbal warning and counseling by the Head Coach and/or Executive Director. § Suspension from practice(s). § Suspension from regatta(s). § Suspension from the team. § Expulsion from the program. § Parent contacted immediately by the Program Director/Head Coach or the SMRC/ETRO Executive Director and the team member is returned home at the parent’s expense. Parents may address any questions or concerns regarding these sanctions or any issues regarding the Youth Rowing Program though the following contacts -‐ directly to the Program Director/ Head Coach or the SMRC/ETRO Executive Director. I, the parent or guardian, certify that not only have I read and agree to these terms, but that I have gone over them with the minor in question and agree to enforce the terms of this Code of Conduct. I have read and agree to abide by the above rules. Athlete Signature___________________________________________________________________ Date____________________ Parent Signature____________________________________________________________________ Date____________________ §
Youth Program Registration Documents 2014-‐2015 SCHOLARSHIP APPLICATION
(All information requested on this form will be held in strict confidence.) Name ________________________________________________ Age ____________ Date of Birth ___________________________ Gender __________________________________ Address ______________________________________________________________ City_____________________ State ______ Zip____________ Phone ____________________ School ________________________ Grade______________ Email Address _____________________________________________________________________________ Name of Parent or Guardian ____________________________________________________________________________________ Address ______________________________________________________________ Phone ____________________________________ Email Address ___________________________________________________________________________________________________ Relationship to Scholarship Candidate ________________________________________________________________________ Scholarship Amount Requested ______________________________ All scholarship recipients must pay a minimum amount (to be determined and based upon ability to pay) and donate volunteer time equal to the amount of the scholarship. $25 = 1 hour of volunteer time. Signature ___________________________________________________________________________Date________________________ Please use the area below (or a separate sheet) to write a brief statement outlining the reason you are requesting this scholarship. _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ Please indicate your volunteer availability. (Days/times/abilities/skills) _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ Return this application to: ETRO Executive Director -‐ Jeffrey Coy – [email protected] or Watt St. CrossFit, Once the application has been received and reviewed you will be contacted with the amount of the scholarship available for your athlete. Please direct questions to Jeffrey Coy – Executive Director SMRC/ETRO. (256-‐289-‐3359) Office Use below: Scholarship Amount __________________________________ Period Covered ________________________________________ Date _____________________________________________________Approved by ___________________________________________ Youth Program Registration Documents 2014-‐2015 SCHOLARSHIP APPLICATION
(All information requested on this form will be held in strict confidence.) Please use this page to track your volunteer hours throughout the year. This page should be turned into the Executive Director at the completion of your program. TOTAL VOLUNTEER HOURS NEEDED_________________