BSC 2018 Junior Camp Registration Form

2020 Buffalo Junior Summer Training Camp August 17 - 22, 2020

For Competitive Junior Skaters Ages 12 to 21
Take Your Skating & Training To The Next Level!

Join us for an intensive 6 day clinic coached by Eastern Regional Camps Director Tom Miller. Coach Miller brings his technique driven training program to Western New York for our annual camp.

The camp is designed for competitive Junior skaters, ages 12 to 21. It incorporates, Ice, Dryland and analyses. Additional training will be provided in the art/sciences of sharpening and blade setup, race preparation and injury prevention.

Sponsored by: The Buffalo Speed Skating Club.

Instructed by: Eastern Regional Camps Director Tom Miller, Additional coaching and supervision will be provided by members of the Buffalo Speedskating Club, and guest coaches.

Location: The Northtown Center at Amherst - 1615 Amherst Manor Drive Amherst, NY 14221

Dates: Monday, August 17 - Saturday August 22.

Total Ice Time: 16.5 hours (on an Olympic size rink). Total Dryland Training: 11 hours.

Registration: The camp will be limited to the first 20 applicants. The single skater fee is $450 USD. The Family discount fee is $400 USD per skater after the first skater in the same family.

Host Families: Due to the current Covid situation hosting is no longer avialable.

After you register: An information/confirmation packet will be emailed to you detailing what you should bring along with additional information about the camp and Western New York.

Athlete Information
Athlete's Name *

First Name Last Name
Birth Date *

Month Day Year
Gender *

Male Female
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Club Name *
USS/Speed Skate Canada number: *
*

400 M time 500 M time
Time *
I would like to stay with a host family: if yes, you will be taken to the Host Family Request Form

Yes
Performance T-Shirt size *

Host Family Request

Please Note: You will be contacted with your host family’s information approximately one week prior to the camp. It will be your responsibility to contact your host family to discuss your participants stay.
Home Life Preferences:
Allergic to Pets? *

Yes No
If yes, what types?
Please list any food allergies and or aversions:
Please list any medical conditions/concerns, and any medications that you will bring along:
Do you request to stay with a particular host family or with another camp participant? Please note that we will do our best to fulfill your request, but it can not be guaranteed. *

Yes No
Host Family:
Skater you would like to stay with:
Other requests/information you would like to share with us:

Parent/Guardian Information (If applicable)
Name

First Name Last Name
Home Number

Area Code Phone Number
Cell Number

Area Code Phone Number
Address (if different from the skater's)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Add one or two additional skaters in the same family

Yes

Additional Athlete's Information
Athlete's Name *

First Name Last Name
Birth Date *

Month Day Year
Gender *

Male Female
Club Name *
*

400 M time 500 M time
Time *
Performance T-Shirt size *
Host Family Request If Applicable
Home Life Preferences:
Allergic to Pets?

Yes No
If yes, what types?
Please list any food allergies and or aversions:
Please list any medical conditions/concerns, and any medications that you will bring along:
Do you request to stay with a particular host family or with another camp participant? Please note that we will do our best to fulfill your request, but it can not be guaranteed.

Yes No
Host Family:
Skater you would like to stay with:
Other requests/information you would like to share with us:
Add a second skater in the same family

Yes

Second Additional Athlete's Information
Athlete's Name *

First Name Last Name
Birth Date *

Month Day Year
Gender *

Male Female
Club Name *
*

400 M time 500 M time
Time *
Performance T-Shirt size *
Host Family Request If Applicable
Home Life Preferences:
Allergic to Pets?

Yes No
If yes, what types?
Please list any food allergies and or aversions:
Please list any medical conditions/concerns, and any medications that you will bring along:
Do you request to stay with a particular host family or with another camp participant? Please note that we will do our best to fulfill your request, but it can not be guaranteed.

Yes No
Host Family:
Skater you would like to stay with:
Other requests/information you would like to share with us:

Informed Consent and Acknowledgement

I acknowledge that, as in all sports and exercise, there is an element of risk and that I am physically and medically capable of participating in skating activities. In consideration of the acceptance of my application and permission to participate in the 2020 Buffalo Junior Summer Training Camp, and in any of the Buffalo Speed Skating Club events, activities, or training sessions.

I myself, my heirs, executors, administrators, successors, and assigns RELEASE, WAIVE and FOR-EVER DISCHARGE the Buffalo Speed Skating Club, It’s organizers and coaches, US Speedskating, The Northtown Center, Town of Amherst, Tom Miller and all other associations, sanctioning bodies and sponsoring companies, and all their respective agents, officials, servants, contractors, representatives, and assigns of and from all claims, demands, damage cost, expense, actions, and causes of action, OF ANY KIND WHATSOEVER, whether in law or equity, in respect of death, injury, loss or damage to my person or property HOWSOEVER CAUSED, arising or to arise by reason of my participation in any event organized by the Club, whether as a spectator, participant, competitor, or otherwise, whether prior to, during or subsequent to the event and notwithstanding the same may have been contributed to or by negligence of any of the aforesaid.

I further undertake to skate safely and wear protective equipment at all times. All skaters must wear an ANSI/SNELL certified helmet, cut resistant neck guard, knee pads, and full fingered gloves. A suit can be worn that incorporates knee pads and a neck guard.

Conduct

All athletes are expected to abide by their governing body’s (USS or SSC), Code of Conduct and by all rules and directions issued by the camp's coachs and staff. In the event that a participant's behavior warrents removal for the camp, the camp director will notify the participant and if apropriate thier parent or guadian. No refund will be provided.

Photography

The camp is being photographed, by attending the camp you consent to having your photo taken. The photographs may be used for the purposes of advertising, editorial or other promotional work.

Cancellations and Refunds

The last date for a cancellation refund is June 1, 2020 unless the spot can be filled. If the spot is filled with an appropriate skater, a full refund will be provided.
Confirmation

BY AGREEING ABOVE AND SUBMITTING THIS FORM, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT IS EQUIVALENT TO AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
I Agree
Contact email:

Confirmation Email
After registering you will receive an emailed confirmation packet. Included in it will be a Skating Goal form an Authorization For Minor’s Medical Treatment form if applicable and a COVID wavier form.
Select an option: *
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New skater registration (single or first skater) $ 450.00

New skater registration (additional family member) $ 400.00

Quantity

Total $ 0.00
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2020 Buffalo Junior Summer Training Camp August 17 - 22, 2020

Host Family Request

Host Family Request If Applicable

Host Family Request If Applicable