|
To
contact us: |
|
Entry Form and
Athletes Release Monthly pricing: 1 day/wk x 4
wks = $140, Unlimited days/locations = $240. Also Beginner to Advanced “Private
Clinics”: $100 per person/per clinic for individual, or $75 per person/per
clinic for multiple. Clinics typically last 1.5 to 2 hours. —
Monthly fees apply to that month only. — There will be no refunds for
no-shows. — Athletes need to come dressed and ready to
participate with your own poles (if possible),
1/4” spikes, flats and sweat suit. — Be prepared for weather conditions. — We
have poles if needed. — No refunds if dismissed for disciplinary or injury reasons. Parental Consent / Waiver I, or we, hereby grant permission for my
child to attend the Rusty Shealy Pole Vault Clinics. I, or we, verify that my child has had a
physical exam in the past year and is capable of participating in the
activities relating to the camp. I, or
we, agree to indemnify, hold harmless and defend Russell W. Shealy, Rusty
Shealy Pole Vault, Carolina Extreme Pole Vault, the host schools and coaches
and/or their respective officers, agents, representative, successors, and/or
assigns from any and all liability for injury to my child, as well as any
injury or damage caused by my child.
Should medical treatment for my child be necessary, I, or we, hereby
authorize any physician or trainer selected by clinic personnel to order and
conduct medical or surgical procedures necessary. In addition, I, or we, hereby grant
permission for Rusty Shealy Pole Vault and/or Carolina Extreme Pole Vault to
use athlete’s name, photographs and/or videotape of related clinic activities
for advertising or educational purposes in any media production. Name _____________________________ Male
____ Female ____ Age _____ Address _______________________ City
_____________ State ___ Zip ______ Telephone _________________________ Email
_________________________ School _________________________ Grade ____
Coach ________________ Best meet vault ____________ Second best
meet vault _____________ Health and Accident Insurance Company __________________________________________________________ Policy #
___________________________________________________ __________________________________________________________ Parent or Guardian Signature __________________________________________________________ Parent or Guardian Name(s) Printed Parent Email
___________________________________ Date ______________ Please mail
Entry Form/Athletes Release, with check payable to: RUSTY SHEALY, Post
Office Box 1502 Cayce, SC 29033, or bring with you when you come. Only one entry form needed per academic
year. Please
note we now
accept credit cards. |
|
Pole Vault Clinics |