Kangaroo Track Club - High Jump Coaching

PLEASE MAKE COPIES OF THE REGISTRATION FORM IF NECESSARY

________________________________________________________________________

Kangaroo TC Long and Triple Jump Camp

at Apple Valley High School

REGISTRATION FORM

Name: ____________________________

School/Club: ________________________

PB: ___________________________

Address

Street : ___________________________________

City: ________________ State: ___________ ZIP: ____________

Home Tel. #________________________

Work Tel: #_________________________

E-mail: _____________________________

Waiver: I know of no mental or physical problems which may affect me or my child's

ability to safely participate at the camp. Coaching staff is authorized to attend to any

health problem or injury to me or my child while attending camp.

Neither I nor my child will hold Kangaroo Track Club liable for any injuries or expenses

while me or my child are at the camp.

I hereby authorize my child's participation in the Kangaroo Track Club High Jump Camp.

___________________________ __________________________

Participant signature Parent signature

(if participant is under 18 years old)

Sessions:

Session 1: From July 7 to July 10 (M-T-W-Th)

Session 2: From July 14 to July 17 (M-T-W-Th)

Session 3: From July 21 to July 24 (M-T-W-Th)

Session 4: From July 28 to July 31 (M-T-W-Th)

Cost: $100 per session/ $270 for 3 sessions / $340 for all 4 sessions

$550 for the athletes that register for all sessions of the high jump, the long and triple jump summer camp.

Note: Athletes that register for all 4 sessions will get priority.

Groups: Group 1: 10am-11:30am /Group 2: 5:30 to 7pm / Group 3: 7 to 8:30pm (Tentative)

Please e-mail or call first to reserve a spot, and let me know that the registration form and fee have been mailed (we will wait 4 days for the registration form).

Please make check payable to Kangaroo Athletics, and mail it with the registration form to:

Hugo Munoz

18465 Eldorado Way

Farmington, MN 55024

Kangaroo Track Club Athlete Profile & Questionnaire

Name: _____________________________

Height: _________ Gender: M F

Date of Birth: ______________

High School / College: _______________________

Year: Senior Junior Sophomore Freshman

USATF MEMBERSHIP #____________________

Uniform Size:

Youth: Sm ? Inter ? Med ? Lrg ? Adult: Sm ? Med ? Lrg ? XLrg ?

Shoe Size: ____________

How long have you been jumping? _____________________

Progression

High Jump Triple Jump

Mark Year Mark Year

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Other events Personal Best

________________________________________________________________________

Why do you want to High Jump or Triple Jump?

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Please describe how you feel and what goes through your mind before the competition (please be as detailed as you can, the more detailed response will allow the coach to help you much more).

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Please describe how do you feel and what goes through your mind during a competition where you are jumping well, and one where you are not jumping well (please be as detailed as you can, the more detailed response will allow the coach to help you much more).

________________________________________________________________________

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Please describe how do you feel and what goes through your mind after a good competition, and a bad competition (Please be as detailed as you can, the more detailed response will allow the coach to help you much more).

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What are your short term jumping goals? (1 -2 years)

________________________________________________________________________

What are your long term jumping goals? (3+ years)

________________________________________________________________________

What are you looking for in a coach?

________________________________________________________________________

Code of Conduct:

I will stress safety in everything I do. This includes not jumping until the coach is watching, no distracting other jumpers in the jumping area.

I will never insult, belittle, degrade, slander, nor express any negative feelings, either verbally or non-verbally, towards another club member or about another club member including coaches.

I will show respect to all meet officials.

I will respect the rights and beliefs of others and will treat others with courtesy and consideration.

I agree to compete fairly and by the rules.

I will respect the property of others.

I will be fully responsible for my actions and the consequences of my actions

I will treat my body properly by getting proper rest, nutrition, and abstaining from use of drugs and alcohol, not abusing medicines and dietary supplements. I will make myself aware of any banned supplements and medicines.

Athlete signature: ________________________

Parent signature__________________________

Parents Contact Information

Fathers Name: ___________________________________

Mothers name: __________________________________

Primary Address

___________________________

Parent Home Phone _____-_____-________

Parent Work Phone _____-_____-________

Parent Cell Phone _____-_____-________

E-mail ________________________________

Other emergency contact: ________________________ Phone # ___________________

I, THE PARENT/GUARDIAN of the club member authorize Kangaroo Track Club to post in the website information about my son/daughter that is intended to promote the club or the athlete. Also to give my contact information to colleges and universities coaches so they can contact me.

Parent/Legal Guardian: ____________________________________________

Date: ______________ Signature: ____________________________________________

PARENT/ GUARDIAN AGREEMENT

I, THE PARENT/GUARDIAN of the club member, a minor, agree that I and the club member will abide by the rules of the Club. Recognizing the possibility of physical injury associated with sports and in consideration for the Club accepting the registrant for its sports programs and activities, I hereby release and discharge the Club, their board members, coaches, volunteers and associated personnel, including ISD 196 and the owners of fields and facilities utilized, against any claim by or on behalf of the club member as a result of the club member’s participation in the programs and/or being transported to or from the same, which transportation I hereby authorize.

Parent/Legal Guardian: ____________________________________________

Date: ______________ Signature: ____________________________________________

CONSENT FOR MEDICAL TREATMENT

As the parent or legal guardian of a participant in the Club and its programs, I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb or well being of my dependent.

Parent/Legal Guardian: ____________________________________________

Signature:______________________________ Date:_____________________________