medical waivers & insurance forms ty · 2019-06-05 · pole vault, shot put, and discus....
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Camp Schedule
Sprints/Hurdles—June 17th
LJ/TJ—June 18th
Pole Vault/High Jump—June 20th
Throws—June 21st
Each day will consist of a morning session (10:00am-
12:00pm) and an afternoon session (1:00pm-3:00pm)
Check-In Check-in will be held in the lobby of the Donald E. Young
Center at 9:30am each day.
Camp Gear
All campers need to bring appropriate training gear, including
spikes, pole vault poles, shots/discs, running and/or throwing
shoes and swim suits. Sunscreen and a water bottle are
encouraged. Extra spending money for vending and/or snacks
may be helpful also.
Facilities We will utilize a combination of both our indoor and outdoor
facilities to give our campers the best experience possible.
Meals
Lunch will be provided for all campers between morning and
afternoon sessions.
Insurance
Each camper must be covered by their own accident and
medical insurance.
Refunds Black Hills State University allows no refunds due to personal
injury, any conflicting camps or tournaments, vacations, etc.
Registration
Pre-registration by June 14, 2019 is preferred - but not
required. Campers can register by mail or online at
www.YellowJacketSportsCamps.com. Please make checks
payable to BHSU Track & Field.
Camp is directed by BHSU Coaches and members of the
Yellow Jacket Track and Field Team
Camp Information Medical Waivers & Insurance Forms
Black Hills State University Parents or Guardians
Agreement of Waiver of Liability, Indemnification
and Medical Release (For use by adults during special events and activities if the participant is under 18 years of age.) Said undersigned parent and natural guardian or legal guardian does hereby represent that he/she is, in fact, acting in such capacity and agrees on behalf of the participant and his/her executors, administrators, heirs, next of kin, successors, and assigns, to: a. waive, release, and discharge from any and all
liability for participant’s death, disability, personal injury, property damage, property theft or actions of any kind which may hereafter accrue to participant and his/her estate, the State of South Dakota, and its officers, agents and employees; and
b. indemnify and hold harmless the State of South
Dakota, and its officers, agents and employees from and against any and all liabilities and claims made by other individuals or entities as a result of participant’s participation or actions during this activity or event.
The undersigned further consents to and authorizes medical treatment to the participant, which may be deemed advisable in the event of injury, accident or illness during this activity or event. This release and waiver shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. I, the undersigned, acknowledge that I have read and understand the above release.
Parent/Legal Guardian Name: _____________________
Signature _______________________________________
Insurance Company: _____________________________
Insurance Policy Number: ________________________
Date____________________________________________
*Insurance is required to participate in camp.
2019 Track and Field Camp Information
Seth Mischke Head Track & Field Coach
21 Rocky Mountain Athletic
Conference champions, 100 All-
Conference honorees, 30 All-American
honors, and two National Champions.
Christopher Fields Assistant Track & Field Coach
Sam Johnson Head Track & Field Coach
Johnson is in his seventh year as the
head coach for the Golden Bears. In
his tenure, the program has set 52
school records and boasts 18 All-
NSIC selections and 12 national
qualifying marks.
Track & Field Camp
Track & Field camp is open to all athletes entering 7th-
12th grades. Each athlete will receive specialized
training in one or more of the following event areas:
sprints, hurdles, long jump, triple jump, high jump,
pole vault, shot put, and discus. Workouts will be
structured to improve technique in each specific event
thru a combination of training, demonstrations, and
drills. There may also be classroom sessions that will
enhance the camper’s technical understanding of the
different events;. Other sessions may include
flexibility, plyometric and strength training.
Camp Costs include coaching, meals, and a t-shirt:
Camper fees $80 per/day
*If a camper attends more than one of the day camps
the price will be reduced to $60 for each additional day.
Our highly qualified staff is capable of teaching the
beginner, intermediate and the most veteran of
performers—and all levels are welcome.
*These are commuter camps and overnight lodging
will not be provided.
Payment Information
BHSU Track & Field
1200 University Unit 9410
Spearfish, SD 57799-9410
BHSU Track & Field Camp
General Information
Camper’s Name:_________________________________________________
Address: ______________________________________________________
City: _________________________________ State:_____ Zip: ___________
Email:___________________________________________________________
Parent’s Name:___________________________________________________
Phone: C:__________________________W:___________________________
Grade Entering Fall 2019:___________DOB:__________________________
T&F Event(s):____________________________________________________
Camp Information
Track and Field Camp—June 17, 18, 20, 21. All camps
are from 10am-3pm.
*Please circle intended dates:
June 17
June 18
June 20
June 21
We look forward to seeing
you at the BHSU track and field camp!
Registration
Camp Contact Information Camp Coordinator: Seth Mischke
Phone: (605) 642-6041
Email: [email protected]
Payment Information for Internal Use:
Payment Type_________ Amount ______
Check # ______________ Date ________