BLACKHEART RUGBY

2016 Spring Rugby Tour

PLAYER PERMISSION SLIP

Today’s Date:______

I, as Parent or Guardian, Give Permission for ______

(Player’s First and Last Name)

To Attend and Fully Participate In:

Event Time: Bus Trip, Hotel, Dinner, Lunch and 2 Rugby Games

Saturday & Sunday, May 12 - May 13, 2016

There is a $15 charge to players for this trip.

1. Mode of Transportation: Bus

2. Players will leave from: Home Depot Strongsville at Pearl & Sprague, report at 6:30am for 7:00am

departure on Saturday March 12th

3. Players will return to: Home Depot Strongsville at approximately 6:00pm on Sunday, 3/13/16

I understand that my child/ward will be obliged to abide by Parma Blackheart Club Rules while participating in this trip/program. In the event of serious illness or injury to my child/ward, I expressly consent to the administration of emergency medical care, if in the opinion of attending medical personnel, such action is advisable.

Further, I authorize the Blackheart Coaching Staff to act on my behalf as parent of my child/ward while participating in the above described trip/program. I have read this Permission Slip and understand its terms. I sign it voluntarily and with full knowledge of its significance.

Parent’s/Guardian’s Signature______

Relationship to Minor______

Address ______

Street Apt. #

______

CityState Zip Code

Home Telephone # ______Work Telephone # ______

Alt Telephone # ______

Emergency Contact (other than yourself) ______

Emergency Telephone Number______.

FILL OUT THIS PERMMISSION SLIP COMPLETELY AND RETURN IT WITH CASH OR CHECK. MAKE CHECK PAYABLE TO PARMARUGBY. PLEASE PUT THIS FORM AND PAYMENT INTO AN ENVELOPE WITH THE PLAYERS NAME

Dear Blackheart Parents,

The Preseason Blackheart Rugby Road trip will be to Cincinnati, Ohio to Scrimmagethe Lakota High School Rugby Team on Saturday, dinner at Dave & Busters, and Scrimmage Pickerington in Columbus on Sunday. The costs and times are listed on the attached forms. This is a team and family event. We ENCOURAGE and NEED parentsto join us. Cost to the Players is only $15for the entire weekend. All Players will be staying in Team Rooms. Parents and Families need to indicate if they need individual rooms or a shared room.

Spring 2016Spring Rugby Tour

Parent Family Form

BLACKHEART RUGBY

The following Parent/Family/Fans are interest in joining the club on this trip

Quantity

______I (we) would like to reserve a seat on the bus (Free).

______I will be driving my own vehicle. Circle one: Can Help Cannot Help

______I (we) need an individual Room(s). Team Cost approximately $110.00

______I am willing to share a room with another chaperone (1 room 2 queen beds)Cost $55

______I (we) would like to join the team for dinner and games at Dave & Buster’s Cost $28

(Price includes a $15 Game Card)

______I (we) would like to join the team for Sunday Lunch ($10)

______Unfortunately, I am unavailable to join the Blackheart this weekend.

WE NEED TO GET A COUNT OF PARTICIPANTS SO WE CAN RESERVE ROOMS. Bring a lawn chair as there is no seating. If you have a “party” type tent please bring it. It will help shield the rain or sun.

All hotel rooms need to be booked before March 6thor we cannot guarantee you a spot. Please fill the player and booster forms completely and return them with a check for the total amount of the trip to a coach or Dave Viancourt NO LATER THAN PRACTICE OF March 3rd.

Thank You

Tom Jones

C: 440-725-6677

KEEP THIS FOR YOUR INFORMATION

Spring 2016 Spring Rugby Tour

BLACKHEART RUGBY

(Please Keep This Page For Your Records)

Money from the team fundraisers and corporate sponsorship will be used to offset the cost of this trip. The team will cover the cost of theBus, Hotel Rooms and some meals for the Players. Players cost is only $15 for the weekend but they should bring a little extra spending money for snacks and souvenirs.

Saturday, March 12th:

  • Bus will leave Home Depot in Strongsville parking lot at 7:00am
  • Drive approximately 4 hours to:
  • Brimelow Rugby Grounds (Cincinnati Wolfhounds) 6441 Stockton Rd, Fairfield, OH 45014
  • 2:00pm A-Side and B-side Scrimmages against Lakota High School
  • Bus Travel toQuality Inn & Suites2463 East Sharon Rd, Cincinnati, Ohio 45241, PH: 513-771-9309
  • 6:00pm Dinner & Games: Dave & Buster’s 11775 Commons Dr Springdale, OH 45246
  • Parents and siblings may join the team for the Dinner and Games for a cost of $28 each. (Price include a $15 game card)

Sunday March 13th:

  • Continental Breakfast at Hotel
  • Bus Departs for Cincinnati @ 10:00am
  • 12:00pm Arrival at Portman Park 7000 Long RdCanal Winchester, OH 43110-970
  • 1:00 A & B Side Scrimmage against Pickerington Marauders Rugby Club
  • 4:00ish Bus Departs for Cleveland
  • 6:00 Arrive at Home Depot – Strongsville, Ohio

Contact Information:

Coach: Bill Rechnitzer C: 440-547-0101

Coach: Nick Tormento C: 216-337-4034

Trip Coordinator: