EAST END ROWING SUMMER RACING PROGRAM

“CAMP KNOX”

East End Rowing introduces CAMP KNOX - its first competitive summer junior racing program! Under the supervision of Michelle Knox Zaloom, 2-time Olympic rower, athletes from the east end will compete at two major summer regattas:

US Rowing National Championships Regatta

July 16-20 (Camden, NJ)

Royal Canadian Henley Regatta

August 5-10 (St. Catherines, ON)

Program Dates:

Start up group meeting Saturday June 7, 2008, at East End Rowing immediately following Empire State Games trials. Program begins Monday June 16^th and ends August 10.

Weekly Practice Schedule:

Monday 7:00 AM and 5:30 PM

Tuesday 5:30 PM

Wednesday 7:00 AM and 5:30 PM

Thursday 5:30 PM

Friday 7:00 AM and 5:30 PM

Saturday TBD

Eligibility:

High School students with at least one year of competitive rowing experience and a 2k erg score of 7:40 or better for boys and 8:30 or better for girls. If the previous erg requirements are not met, other criteria may be taken into account.

Cost: $750 - Includes East End Rowing boat usage fee, race fees, uniform, and t-shirt. Does not include travel. All participants must have a valid (through 8/12/07) U.S. passport. You will not be able to go to Canadian Henley without one.

If interested: Fill out the application and medical form below. Mail all 2008 summer forms with check payable to “Camp Knox” to:

CAMP KNOX

PO Box 68

Mattituck, NY 11952

APPLICATION DEADLINE IS JUNE 7. A $100 DEPOSIT IS REQUIRED WITH APPLICATION. THE DEPOSIT IS REFUNDABLE UNTIL JUNE 16.

2008 APPLICATION

CAMP KNOX SUMMER JUNIOR RACING PROGRAM

East End Rowing Institute

Flanders, NY 11901

Name: _______________________________________

Street_________________________________________________________________________City_____________________________________ State __________ Zip___________________

Phone-Home: ______________________________Phone-Mobile: ________________________

Email: ______________________________________Birth Date: _________________________

Current school: ______________________________Yrs experience_______________________

Competitive experience: ______________________________________________________________________________

2K erg time (n/a for coxswains) ____________________________________________________

Physical Condition

1. Date of most recent physical examination: __________________________________________

2. Name and phone number of doctor:________________________________________________

3. Any physical impairment: _______________________________________________________

Applicant’s Signature: _______________________________ Date: __________

PARENTAL CONSENT FOR ALL APPLICANTS UNDER 18 YEARS OF AGE

We, _________________________________________________________________

(please print clearly)

the parents/legal guardians of ____________________________________ authorize our child to join East End Rowing and to participate in its 2008 Summer Program, including training and competing for East End Rowing in national and international competitions (which involve travel to and from and lodging in other cities). We believe our child is physically, mentally and emotionally qualified to participate in all aspects of the Summer Program.

We understand that rowing is a sport posing significant risks and release East End Rowing, its coaches and other contractors, its directors, officers and employees from any and all liability arising from my child’s injury, death or loss of property during the Summer Program and so long as s/he is a member of East End Rowing Institute.

We agree to be responsible for any uninsured damage to the property of others caused in whole or in part by our child during the Summer Program.

Parent or guardian: ________________________________________ Date: __________

East End Rowing Institute

Medical Information andEmergency Medical Treatment Authorization Form

2008

Rower ____________________________________________ Birth Date______________________

Address_______________________________________City_________________State___Zip_______

Mother’s Name________________________________ Home Phone: ______________________

Work Phone: ______________________ Cell Phone: ________________________

Father’s Name_________________________________ Home Phone: ______________________

Work Phone: ______________________

Cell Phone: ________________________

Facts concerning the Rower’s medical history the coaches and a medical service provider should know:

Allergies: _____________________________________________________________________________

Medications taken daily or routinely: ______________________________________________________

______________________________________________________________________________________

Any physical impairments or other pertinent medical information: ____________________________________________________________________________________________________________________________________________________________________________

Medical Insurance Co.__________________________________ Policy #_________________________

In an emergency, the coaches will first attempt to contact the Rower’s parents, and then will attempt to contact the following individuals so s/he may help us in our efforts to contact the Rower’s parents:

Name/relationship to Rower: ______________________________________ Phone: _______________

We, the Rower’s parents, authorize East End Rowing Institute, its coaches and other independent contractors and its employees to contact the following medical care providers and hospital if they believe emergency medical treatment is appropriate:

Physician’s Name: _________________________________ Phone#:____________________________

Dentist’s Name: ___________________________________ Phone#:____________________________

Local Hospital of choice_____________________________ Phone #___________________________

MEDICAL TREATMENT AUTHORIZATION: If neither of the Rower’s parents is available after the coach has called the phone numbers provided, we authorize:

1. The administration of any treatment deemed necessary by the medical care providers we have specified, or if s/he is not available at the time treatment is appropriate, by another licensed physician or dentist; provided that no major surgery may be performed unless the opinion another licensed physician or dentist concurring in the necessity for that surgery is first obtained.

2. The transfer of the Rower to any reasonably accessible hospital.

Parent or legal guardian: ___________________________________ Date: _________________

NO AUTHORIZATION: We do not consent to any emergency medical treatment of our child, other than life saving measures, without our specific authorization.

Parent or legal guardian: _________________________________ Date____________________