Assumption of Risk and Release and Medical Consent Name of Child (PRINT Last Name, First Name, Middle Initial): _______________________________________________________________________________

University of Hawaii Baseball Office 1337 Lower Campus Road Honolulu, HI 96822

I certify that the above named child is in good physical health and able to participate in 2017-2018 Winter Baseball Camp presented by the University of Hawai`i, which is scheduled for January 6-7. I understand and acknowledge the dangers and risks involved in my child’s participation in the camp which include, but are not limited to, minor injuries such as bruises, lacerations, strains, and sprains, over exertion injuries (such as heat stroke, cardiac arrest or respiratory arrest), broken bones or dislocations or the possibility of permanent disability and death, as well as property loss and severe social and economic loss. The dangers and risks may be caused by, but are not limited to: (a) the actions, omissions or negligence of the instructors, sponsors, participants, volunteers, spectators; (b) conditions of the premises and/or equipment used; (c) temperature and/or weather; (d) conditions of other participants. I understand that as a parent/guardian of the above named child, I am encouraged to obtain a physician’s clearance for my child prior to participation in the above named activity. I understand that my child should have his/her own private medical and liability insurance coverage if they intend to participate in the camp, and that the University of Hawai`i does not provide insurance for my child and will not be financially responsible for my child or indemnify my child with respect to injuries or liabilities arising out of my child’s participation in the camp. The camp will attract media coverage. My child may be photographed and/or video taped while participating in the camp, and the photograph and/or video tape may appear in print media and/or live or replay telecast. I therefore grant my permission for my child to be photographed and/or appear in a telecast of the camp if my child participates in the camp. In consideration of my child being permitted to participate in the camp, I agree to assume all risks of injury and loss resulting from my child’s participation in the camp. I read and understand all written materials setting forth the requirements for my child’s participation, and understood all oral instructions, and my child will strictly observe them during his/her participation. Most importantly, for myself, my heirs, executors, and administrators, I accept full responsibility for my child’s participation in the camp and I agree to defend, indemnify, release and discharge the State of Hawai`i, the University of Hawaii, its Board of Regents, officers, employees, agents and assigns from any and all liability, claims, demands or actions for property damage, personal injury and/or death arising or resulting from or caused by any acts or omissions by my child or others during their participation in the camp. I also agree that this Agreement shall be construed in accordance with the laws of the State of Hawai‘i. I further agree that if any portion is held invalid, the remainder will continue in full legal force and effect. I have read this Assumption of Risk, Release and Indemnity Agreement and I understand that I am giving up substantial rights, including the right to sue. I acknowledge that I am signing this Agreement freely and voluntarily. Signature of Parent(s)/Guardian(s)___________________________________________________ _______________________________________________________________________________ Print Name Date MEDICAL CONSENT FORM I, the undersigned, consent to, and authorize any medical professional and others working under their supervision to treat my child for any injury or illness arising from or related to my child’s participation in the camp, and agree to pay any and all medical expenses, costs and other charges, and to defend, indemnify, release and discharge the State of Hawai`i, the University of Hawaii, its Board of Regents, officers, employees, agents and assigns from any and all liability, claims, demands or actions arising from or connected with such medical treatment or care. Signature of Parent(s)/Guardian(s)___________________________________________________ Print Name______________________________________________________________________ Date EMERGENCY CONTACTS: First Person to Contact: ____________________________________ Phone:________________ Second Person to Contact:___________________________________ Phone:________________ Physician to Contact:____________________________________ Phone: __________________ Medical Insurance Information (if applicable): Carrier Name (i.e. HMSA, Kaiser, etc..):

UH Rainbow Warrior Baseball Winter Camps

_______________________________________________________________________________ Subscriber Name: ________________________________________________________________ Subscriber ID Number: _______________________________________ Preferred Hospital Facility: _______________________________________________

1337 Lower Campus Road Honolulu, HI 96822 Phone: 808-956-6247

Camp Registration: UH Rainbow Warrior Baseball Winter Camps

_______________________________________________ Last Name First Name Middle Initial

Staff – Coach Mike Trapasso and the UH coaching staff will conduct the camps with the assistance of UH players and area high school coaches. There will also be an athletic trainer on hand at all times. Method – Our two-day specialty camps are designed to improve development in the important areas of pitching, infielding, and hitting. The techniques and mechanics taught will be exactly the same as those taught by the UH coaches to their athletes. Campers – The UH Rainbow Baseball Camps are suited for beginning to advanced level baseball players, ages 7-18 years old. Facilities – Les Murakami Baseball Stadium on the campus of the University of Hawaii at Manoa. Indoor facilities will be available in the event of inclement weather.

_______________________________________________ Parent/Guardian’s Last Name, First Name

Camp Schedule January 6-7, 2018 Pitching or Infielding

University of Hawaii Head Baseball Coach Mike Trapasso invites you to our 2017-2018 Winter Camps. “It’s a great opportunity for players ages 7-18 to improve their skills. The instruction will be in depth, worthwhile, and fun!”

Winter 17-18

9:00am-12:00pm

_______________________________________________ Mailing Address _______________________________________________ City State Zip

Hitting 1:00pm-4:00pm

Camp Check-in: 

Each camper must check-in on the first day of camp between 8:00 & 9:00 am or between 12:00 & 1:00 pm for afternoon camps.

What to bring:     

Proper clothing/shoes – shorts may be worn Baseball hat Baseball glove for pitching/infielding camp Baseball bat for hitting camp Lunch – if the camper is staying all day

Cancellation Policy: 

If a camper cancels for any reason, a fee of $35 will be assessed.

For more information, please contact: [email protected] or (808) 956-6247

_______________________________________________ Home Phone Number Oahu Contact Number _______________________________________________ Email Address (necessary to receive confirmation of registration) _______________________________________________ Grade in School Birthdate Age For grades 9-12 was your child a letter winner?

If yes, what year was the award received? ________ JV or Varsity

Dates

Camp

Times

Cost

January 6-7

Pitching or Infielding (please circle one)

9am - 12pm

$100

January 6-7

Hitting

1pm - 4pm

$100

REMEMBER to include the assumption of risk & release and medical consent portion of this form

“X”

T-Shirt Size (Please circle one): Youth: S M L

or

Check # __________

REGISTER & PAY FOR CAMP ONLINE hawaiiathletics.com

YES or NO

Adult: S M L XL Amount $__________

If paying by check, please make payable to “University of Hawaii” and mail with forms to: University of Hawaii Athletics Business Office - Camps 1337 Lower Campus Road, Honolulu, HI 96822 NOTE: $25 bank fee will be charged for all returned checks