Summer EliteShowcase JUNE 21& JULY 26 2016

APPLICATION/WAIVER

**Open to any and all entrants, limited only by GRADE 8th& up and # of participants (75)

**Camp is not owned or operated by Asbury University

NAME:______COST:$125/athlete/CLINIC

ADDRESS:______

CITY:______ST:____ZIP:______Mail applications to:

EMAIL:______Samantha DeMartine

PHONE #______1 Macklem Drive

POSITION(S):______Grad Yr:______Wilmore, KY 40390

ACT/SAT:______GPA:______

Payment Method: $______Total EnclosedCIRCLE ONE

Circle: CASH or Check-made to Samantha DeMartineJune 21 or July 26 or BOTH

Day Clinic Description:@Asbury University Softball field

This camp will run from9:00am - Noon (skills portion of the camp) and1:30pm - 5:30pm (scrimmages-coached by college coaches; Attending college coaches-Union College, Indiana University-Southeast, Brescia University, Midway College, Pikeville University.)

I hereby request that you accept this application for the Summer Elite Showcase and allow my child, ______to participate in the clinic during the dates set forth in this application and for which I have applied. I recognize that there are dangers, risks and possible injuries to Child which are inherent in and may result from participation in Camp activities. In consideration of your acceptance of this application and allowing Child to participate in the clinic, I hereby release Summer Elite Showcase, authorized clinic personnel, Asbury University, including its regents and employees,from any liability, cost or damages should any injury or illness occur to my child while participating in the clinic or which may in any way arise from or relate to the Clinic, including serious injury or even death. I have instructed Child to obey all rules, regulations and instructions of the Clinic Sponsor, including all authorized Clinic personnel, in an effort to help minimize such risk. Child is in good physical health and fitness to allow him to participate in the Clinic. In the event of possible injury, I give permission for the administration of emergency medical care to Child I agree to be responsible for all costs which may be associated withmedical care provided to child. Below is the applicable and accurate medical and insurance.

INSURANCE COMPANYINSURANCE POLICY #

:______

Any and all restrictions, medical conditions, allergies or medications applicable to child:

______

I have fully read and agree to the terms of this Release and Authorization for Medical Treatment.

Parent/ Guardian Signature:______

Print Name:______Date:______

First Emergency Contact Name:______Home Phone#______Cell #______

***Questions contact Samantha DeMartine at