National Sports Center for the Disabled - outdoor recreation opportunities for individuals with disabilities

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Date: Saturday, June 19th 2010
Time: 3:00 PM - 7:30 PM
Location: Infinity Park
4400 E. Kentucky
Glendale, CO 80246

3:00 - 3:30pm	Registration & Check In
3:30 - 4:45pm	Rugby Skills Clinic
4:45 - 6:00pm	Snacks & Giveaways
6:00 - 7:30pm	Glendale Raptors Rugby Game * free admission to all camp participants and families!

This free interactive camp allows kids with disabilities, either physical or developmental, ages 6-18 to experience first hand the sport of rugby. This fun-filled day will include instruction and skill development, use of equipment, games, prizes and ends with a snack. Appearances could include players, coaches and the mascots.

Sports Camp Registration Form
Sports Camp:
Participant First Name:
Participant Last Name:
Parent/Guardian Name:
Address:
City:
State:
Zip Code:
Phone:
Email Address:
Age:
Date of Birth:
Sex:	Male Female
Disabilities:
Seizures:	Yes No
Medications:
Wheelchair:	Manual Power
Emergency Contact:
Emergency Contact Phone:

Sports Camp Participant Waiver of Liability
In consideration of my child (participant) being permitted to participate in the Raptors Rugby Sports Camp offered by the National Sports Center for the Disabled and the Glendale Raptors, Infinity Park and the City of Glendale, on behalf of my child, myself, and anyone who obtains rights from my child or me, I hereby voluntarily waive, fully release and discharge any of the above mentioned agencies and entities, their directors, officers, employees, agents, insurers, various sponsors and paid and non-paid volunteers from liability for injury, illness, death, damage or loss to participant or participant's property arising out of or in any way related to Participant's activities at the Raptors Rugby Sports Camp. I understand that the staff/volunteers of this camp are not allowed to administer medication or provide personal care such as feeding, toileting, and/or dressing. Anyone needing this type of assistance must make their own arrangements. I have read this form and understand its content and request registration for my child.
Agree:	Yes No
Photo Release

I grant permission for Participant's picture to be used in publicity or brochures related to this event.
Agree:	Yes No
Participant Name:
Parent/Guardian Signature:
Date:
By checking this box, this will act as your digital signature.	I agree
Please print this page out and bring it to the camp with you.

P.O. Box 1290, Winter Park, Colorado 80482 USA ph: 970.726.1540 or 303.316.1540 fx: 970.726.4112
Denver Office: 1801 Bryant St, Ste 1500, Denver, CO 80204 ph: 303.293.5711 fx: 303.293.5448 Email: info@nscd.org
KC Office: 4600 63rd St, Kansas City, MO 64130 ph: 816.513.7571 Email: infokc@nscd.org

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