Athletic Clinic Registration

Registration Deadline: Monday, July 1, 2019

Registrations received after the deadline may be subject to a $20 late fee and will not be eligible to receive a t-shirt.

This form MUST be completed by each participant on or before the start of the Athletic Clinic. No exceptions.

Clinic times vary depending on the sport. All camps take place Monday through Thursday, with the exception of cheer, which is Monday through Wednesday. Please see the detailed schedule of dates and times below.

Dates & Times

Cheer Stunt Clinic	TBA	TBA
Volleyball Clinic Week 1*	July 8th through 11th	5:00 to 7:00 p.m.
Basketball Clinic	July 8th through 11th	7:00 to 9:00 p.m.
Lacrosse Clinic	July 15th through 18th	5:00 to 6:30 p.m.
Soccer Clinic	July 15th through 18th	6:30 to 8:30 p.m.
Volleyball Clinic Week 2*	July 29th through August 1st	5:00 to 7:00 p.m.
Softball	July 29th through August 1st	7:00 to 9:00 p.m.

*Volleyball clinics require a minimum of 18 participants and are capped at a maximum of 24.

Student Information

Full Name:*

Answer Required

Entering Grade:*

Answer Required

Birthdate:*

Answer Required

Cell Phone:*

Answer Required

Address

Street Address:*

Answer Required

City*

Answer Required

Zip/Postal*

Answer Required

Home Phone:*

Answer Required

Parent/Guardian Information

Primary Parent/Guardian Name:*

Answer Required

Primary Parent/Guardian Email:*

Answer Required

Primary Parent/Guardian Cell:*

Answer Required

Secondary Parent/Guardian Name:

Answer Required

Secondary Parent/Guardian Email:

Answer Required

Secondary Parent/Guardian Cell:

Answer Required

Emergency Contact Name:*

In the event either parent cannot be reached.

Answer Required

Emergency Contact Details:*

Address and Best Contact Number

Answer Required

Health Insurance Information

Insurance Provider:*

Answer Required

Policy #:*

Answer Required

Company Address:*

Answer Required

Phone:*

Answer Required

Are there any medical conditions/allergies that we should be aware of?*

Examples: Asthma, Carries an Epi-pen for Severe Allergies, Seizures, etc.

Answer Required

Yes

If yes, please explain below.

Answer Required

Medical Treatment Authorization and Liability Release

My daughter elects to take part in the Mary Help of Christians Academy Blue Jay Athletic Clinic(s). I acknowledge that this is an extracurricular activity in which my daughter is participating voluntarily and understand that there may be some risks of illness or injury (minimal, serious, or catastrophic) in connection with the activity itself and/or transportation to and from the activity. In consideration of my daughter being permitted to participate in the activity, I hereby assume all of these risks and waive any possible claim that my daughter or I might have against Mary Help of Christians Academy athletic programs, Mary Help of Christians Academy, and any employees, agents, or students, in conjunction with our participation in this activity. I further acknowledge that the above individual is covered by health insurance. I hereby agree that I am responsible for all medical treatment, and give permission for my child to receive medical treatment in the event that I am unable to be contacted. I hereby hold Mary Help of Christians Academy and its coaches and their directors and representatives harmless in exercise of this authority. I also give permission for Mary Help of Christians Academy to use photographs taken of my child at the clinic to post online or use of future posters.

I acknowledge that have read and understand the medical treatment & liabilty release statement contained herein and give consent.*

Answer Required

Parent must click here.

Enter Full Name as Signature:*

Answer Required

Date*

Answer Required

Clinic Selection

All prices include a 4% credit card processing fee. To arrange alternate payment methods, please contact the Athletic Director.

Cheer

Price: $83.20

Volleyball Week 1

Price: $83.20

Basketball

Price: $41.60

Lacrosse

Price: $41.60

Soccer

Price: $41.60

Volleyball Week 2

Price: $83.20

Softball

Price: $41.60

T-Shirt Size*

Shirts will only be ordered only if at least 15 athletes have registered for the clinic by the July 1st deadline.

Answer Required

Adult Small

Adult Medium

Adult Large

Adult XL

Adult XXL

Other:

Please fix the highlighted areas below before submitting.

Athletic Clinic Registration