Blackburn College Women`s Soccer I.D. Camp
Event Timing:  Saturday, July 13th, 2024 10:00am-6:00pm
Event Address: 700 College Ave, Carlinville, IL 62626
Contact: John Mansholt - Email: john.mansholt@blackburn.edu
                Gabe Attanasio - Email: gabriele.attanasio@blackburn.edu
There is no charge to attend this event.
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Name *
Prospective Student Athlete Cell Number
Email *
Class/Graduating Year
*
High School- Please, include Head Coach Name & Contact Information
*
Club Team- Please, include Head Coach Name & Contact Information
*
Positions you are comfortable playing
*
List any people accompanying you to the ID Camp and their relation to you.
Food Allergies (There may be snacks provided and we would like to ensure the safety of all in terms of food restrictions)
Your answer

In consideration of being permitted to participate in the Blackburn College Women`s Soccer ID Camp, I agree to the terms set forth in this agreement.   I hereby certify that I am/my child is/physically fit to participate in  the  Blackburn College Women`s Soccer ID Camp. I am executing this agreement on behalf  of myself,  individually, and on behalf of my family members, heirs, estate, executors, personal representatives,  administrators  and assigns. I acknowledge that there exist heightened and unpredictable health risks associated with the COVID-19 virus.  These risks include exposure to asymptomatic carriers of the COVID-19 virus and the transfer of the virus through interpersonal communications and/or sharing spaces with others.  I acknowledge that it is my responsibility to abide by any preventative guidelines required by the College for participation in this event. I further understand my refusal to wear a mask when required or adhere to other safety protocols mandated by the College for this event will result in my immediate removal from the activity.  I also acknowledge my obligation to monitor for symptoms prior to my participation in the event and to stay at home should I be symptomatic.  MEDICAL AUTHORIZATION:  I acknowledge that I am responsible for all medical and other costs arising out of bodily injury or any loss sustained through participation in the Sports Camp.  I hereby authorize and give my consent to Blackburn College coaches or camp staff to act on my behalf to secure any hospital,  physician,  ambulance  and/or  medical  personnel  for immediate  treatment  deemed  necessary  in connection with the Sports Camp.  I understand that should an emergency medical problem arise, an attempt will be made to call the emergency phone number(s) that I have provided.   In the event that the emergency contact cannot be reached, I hereby give consent to such treatment as deemed necessary by a licensed health care professional.  ASSUMPTION OF RISK:  I understand that participation in the Sports Camp at Blackburn College involves the substantial risk of injury, including but not limited to cardiovascular stress, head and brain injuries including concussion, and damage to bones, joints, muscles, internal organs, and the spinal cord or column.  I understand that the risk of such injuries cannot always be reduced or prevented despite the best efforts or due care by Blackburn College coaches or camp staff.  I further understand that any injuries I/my child suffer(s) during participation in the Sports Camp could lead to permanent physical or mental impairment, cognitive deficits, paralysis or even death.  I hereby assert that my/my child’s participation in the Sports Camp is voluntary, and that I knowingly assume all risk of injury.   RELEASE and GENERAL LIABILITY WAIVER:   I hereby  release, waive, discharge and covenant not to sue  Blackburn College of and from any and all claims, suits, actions, or causes of action (collectively, "Claims")  arising out of or related to my/my child’s participation in the  Women`s Soccer ID Camp,  including  but not limited  to Claims  for  wrongful  death,  personal injury, property damage, loss or theft of property. MEDIA RELEASE:  I hereby consent to the use of my/my child’s photograph, image, voice, written and/or verbal statements (“materials”) by Blackburn College in its publications, videotaping, advertisements, brochures, websites, etc.
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