Camp registration now open!

Camp registration now open! Open to novice and experienced Belen registered students in grades 6-12 New rowers will learn the basics of crew & experienced rowers will improve their technique and skills Row Hard & Have Fun! Camp Dates (1-week session) Camp Cost Camp space is limited REGISTER NOW! June 20-24 8am-5pm June 27 Jul 1 8am 5pm $475 for 1-week session ($50 Registration Fee, including free t-shirt + $425 Tuition ) This 1 -week session comprises 5 days of rowing training, including conditioning work, particular emphasis in technical development, and instruction on water both on sculling and sweep boats. Campers should bring their lunch and water bottle each day. The camp is designed for all levels of experience, from true novices to those rowers and coxswains with racing experience, as campers will be specially working on core stabilization, conditioning and base fitness at their particular level. In addition, each camper will have the opportunity, subject to safety considerations, to row in 8 s, 4 s, 4x s, and 2x s, with the goal of improving their off-water technical as well as on-water boat handling skills. Crew Team at the Boathouse For more information and registration papers, please check our website at www.belencrew.org

2015 BELEN JESUIT PREP CREW INFORMATION Belen Jesuit Prep Crew is excited to offer its 2016 summer rowing camp for new and experienced male Campers who are registered students in grades 6-12 at Belen as of Fall of 2016. The 1 week camp runs from 8:00 a.m. to 5:00p.m. Monday-Friday. Our goal is to offer a safe and enjoyable environment while teaching new rowers the basics of crew and improving the technique and skill sets of experienced rowers. CAMP DATES (CHOOSE A SESSION BELOW) 1-WEEK SESSION : EITHER June 20 - June 24 OR JUNE 27 JULY 1 CAMP COST: $475 per 1-week session ($50 one time registration fee + $ 425 per session tuition) The camp costs will be as follows: $50 Non-refundable one-time registration fee per camper (includes free camp t-shirt); plus $425 per camper, per session tuition. HOW TO REGISTER AND PAY Registration and payment must be received prior to the start of the session either via email or in person, as follows: o Email completed and signed registration form and credit card authorization to Ms. Queta Céspedes by fax at 786.621.4030 or by email to ecespedes@belenjesuit.org o In Person completed registration form, check, and/or credit card authorization may be brought to the Belen Jesuit Preparatory School office at 500 SW 127 Avenue, Miami, FL 33184; or hand-delivered to Coach Yunian as previously arranged by calling him at 305-519-2112 or by email to rowbelen@yahoo.com IMPORTANT INFORMATION: o Camp space is limited. Campers will be notified via e-mail of acceptance into the session of choice. If the selected session is full, campers will be asked to select another session. o Cancellation Policy: A full refund is available for cancellations 2 weeks prior to start date. A $50 administration fee will be deducted from cancellations received less than 2 weeks before the camp start. Please e-mail cancellation and refund requests to Coach Yunian at rowbelen@yahoo.com o Camper Attire and Drop-off/Pick-up Logistics: Campers shall wear camp t-shirt, shorts, and cap or hat and bring a water bottle every day. Campers should apply sunscreen and mosquito repellant before coming to camp every day. Campers shall be dropped-off not earlier than 7:45 a.m. and picked up promptly at 5:00p.m. every day by the school baseball field. Campers will be transported to and from the boathouse by school bus.

REGISTRATION FORM Please fill out and turn in with your payment all 7 pages of this registration form CAMPER S NAME: AS OF FALL 2016 REGISTERED IN GRADE AT BELEN JESUIT PREPARATORY SCHOOL. T-SHIRT SIZE (Circle one ) XS S M L (Please note that these are Adult sizes) PAYMENT METHOD (check one) Paid via email Delivered check or credit card authorization in person to Belen Jesuit on, 2016. STREET ADDRESS: CITY: STATE: ZIP CODE: PHONE(S): HOME: CELL: OTHER: CAMPER S E-MAIL (required): DATE OF BIRTH: HEIGHT: WEIGHT: GENDER: Male/Female (circle) PRIOR ROWING EXPERIENCE (Yes/No): OTHER SPORTS: 1 P a g e

PARENTS AND/OR LEGAL GUARDIANS (CIRCLE PARTY RESPONSIBLE FOR PAYMENTS) FATHER S NAME: Occupation: Phone(s): Work: Cell: Home: E-Mail (Required): Please note that e-mail is our primary mode of contact with you. Please provide an e-mail you check regularly. MOTHER S NAME: Occupation: Phone(s): Work: Cell: Home: E-Mail (Required): Please note that e-mail is our primary mode of contact with you. Please provide an e-mail you check regularly. PERSONS AUTHORIZED TO PICK UP CAMPER NAME RELATIONSHIP (family/friend) Check here if your child is permitted to depart the premises on his/her own I hereby certify that my child, listed above, can swim and stay afloat independently for 15 minutes. PARENT/GUARDIAN SIGNATURE: DATE: 2 P a g e

CODE OF CONDUCT Every camper participating in the Belen Jesuit Prep Summer Rowing Camp is expected to engage only in those activities that will promote the reputation, character, health and welfare of the individual, the team, the Belen Jesuit Preparatory School organization, and the community. The Code of Conduct that all rowers and their parent/guardian sign is central and critical to the smooth functioning of Belen Jesuit Prep Crew. Adherence to and enforcement of the Code is for the benefit of all campers. Coaches who discover a violation will consider the severity of the violation in the context of its impact to the team effort or safety of individual(s). The coach will discuss the violation with the rower and his/her parent(s)/guardian(s). At the coach s discretion, and based on the severity of the case, the coach will request dismissal of the rower. No refund of dues/fees that were previously paid will be granted. Therefore, every camper must comply with the following (please make a duplicate copy for your records). I,, promise that I will: Camper s Name Abstain from the use of alcohol, tobacco, illegal substances, and illegal weapons at all times. Not use abusive, disrespectful, and/or offensive language while on Belen Jesuit, City of Miami, Miami-Dade County property, representing Belen Jesuit Prep Crew in the community, and/or participating in any event as a camper for Belen Jesuit Prep Crew. Not use abusive, disrespectful, offensive, and/or inappropriate behavior (kissing, touching) while on Belen Jesuit, City of Miami, Miami-Dade County property, representing Belen Jesuit Prep Crew in the community, and/or participating in any event as a camper for Belen Jesuit Prep Crew. Demonstrate respect for Belen Jesuit Prep Crew coaches, school administration, and parents. Give due and proper respect to other teams and their coaches. Give due and proper respect and assistance to my teammates and other campers on and off the water. Use consideration and care when using the property of Belen Jesuit Prep Crew, City of Miami, or Miami- Dade County; and cause no deliberate damage to this property at any time. Be punctual for camp and other rowing/camp functions. Abide by all Belen Jesuit Prep Crew rules. I understand that violation of the Code of Conduct may result in disciplinary action as determined by the coaches, athletic director, and/or school administration. Camper s Name (Print) Parent or Legal Guardian s Signature Camper s Signature Date 3 P a g e

MEDICAL RELEASE EMERGENCY INFORMATION FOR: (Name of Camper) Known Allergies: PARENT/GUARDIAN S NAME: Phones: Home: Cell: Work: Other: Address: PARENT/GUARDIAN S NAME: Phones: Home: Cell: Work: Other: Address: PERSON TO NOTIFY IN CASE NEITHER PARENT/GUARDIAN CAN BE REACHED NAME(S) Phones: Home: Cell: Work: Other: Address: PHYSICIAN S NAME: Phone: Please check with a physician before beginning the rowing program and list any medical problems, allergies, and/or medications of which the coaches should be aware. You may attach an additional sheet if necessary. This information will remain confidential. INSURANCE INFORMATION Name of Insurance Company: Policy/Group No. Name of Primary Insured: Insured s DOB: This form authorizes emergency treatment for (Name of Camper) in the event that it is required and a parent or other responsible adult cannot be reached to give such authorization. I understand that Belen Jesuit Prep Crew will make every effort to contact me in the event of such an emergency. Signature of Parent/Guardian Date 4 P a g e

RELEASE OF LIABILITY IN CONSIDERATION of being given the opportunity to participate in any rowing activity, including scheduled, supervised camp activities, during the dates listed below, I, for myself, my personal representatives, assigns, heirs, and next of kin, do hereby: 1. ACKNOWLEDGE, agree, and represent that I understand the nature of rowing activities (the Activity ); both on water and land based, and that I am qualified, in good health, and in proper physical condition to participate in such the Activity. 2. FULLY UNDERSTAND that: (a) THE ACTIVITY INVOLVES RISKS AND DANGERS of serious bodily injury, including permanent disability, paralysis and death ( Risks ); (b) these Risks and dangers may be caused by my own actions, or inactions; the actions or inactions of others participating in the Activity; the condition in which the Activities takes place; or the negligence of the Releasee named below; (c) there may be other risks, and social and economic losses either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation in the Activity. 3. AGREE AND WARRANT that I will examine and inspect each Activity in which I take part as a participant in the Belen Jesuit Prep Crew Summer Camp program, and that, if I observe any condition which I consider to be unacceptably hazardous or dangerous, I will notify the proper authority in charge of the Activity and will refuse to take part in the Activity until the condition has been corrected to my satisfaction. 4. HEREBY RELEASE, discharge, and covenant not to sue Belen Jesuit Preparatory School and/or Belen Jesuit Prep Crew, their administrators, directors, agents, officers, volunteers, and employees, and if applicable, owners and lessors of premises, on which the Activity takes place, (each considered one of the Releasees herein), from all liability, claims, demands, losses or damages on my account caused or alleged to be caused in whole or in part by the negligence of the Releasee or otherwise, including negligent rescue operations, I FURTHER AGREE that if, despite this release and waiver of liability, assumption of risk, and indemnity agreement, I, or anyone on my behalf, makes a claim against any of the Releasees, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS each of the Releasees from any litigation expenses, attorney fees, loss, liability, damage, or cost which any may incur as a result of such claim, to the fullest extent permitted by law. I have read this agreement, fully understand its terms, understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it (Page 1 of 2) 5 P a g e

RELEASE OF LIABILITY (CONTINUED) to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid, the balance, notwithstanding, shall continue in full force and effect. Name of Camper (Print) Camper s Signature (if age18 or over) Date Address: City: State: Phone: E-Mail: PARENTAL CONSENT And I, the minor s parent and/or legal guardian, understand the nature of the Activity and the minor s experience and capabilities, and believe the minor to be qualified to participate in such activity. I HEREBY RELEASE, discharge, covenant not to sue, and AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS each of the Releasees from all liability, claims, demands, losses, or damages on the minor s account caused or alleged to be caused in whole or part by the operations, and further agree that if, despite this release, I, the minor, or anyone on the minor s behalf makes a claim against any of the above Releasees, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS each of the Releasees from any litigation expenses, attorney fees, loss liability, damage or cost which may incur as the result of any such claim. Printed Name of Parent/Guardian Date Parent/Guardian Signature (if camper is under age 18) (Page 2 of 2) 6 P a g e