Circle student’s choice(s): So ball Camp (May 31, June 1 & 2) Golf Camp (June 5 & 6) Cross Country Camp (June 5 ‐ 9) Basketball Camp (June 19 ‐ 23) Volleyball Camp (June 26 ‐ 29) Soccer Camp (August 7 ‐ 11) Name of student: ______________________________ Male_____ Female_____ Birthdate _______________ Address: _____________________________________ ____________________________________________ City, State, Zip: ________________________________ School: ______________________________________ School grade completed by May ‘17: ______________ Parent/Guardian: ______________________________ ____________________________________________ Phone: ______________________________________ Email: _______________________________________ T‐shirt size: YS YM YL AS AM AL AXL AXXL Payment: Cash _____ Check _____ Card _____ Visa/MC/Disc/AX (circle) Card Number: ________________________________ Exp. Date: _____/_____ 3‐digit security code: ______ Name on card: ________________________________ Make check payable to Carl Sandburg College. Check registra on deadlines under each sport info sec on. No refunds will be provided aŌer the deadline
date. Please no food items containing peanut bu er. ** Registra on form and the parent agreement must be submi ed together. Return to Carl Sandburg College, Main Campus, Center for Manufacturing Excellence Bldg, 2051 Tom L. Wilson Blvd., Galesburg, IL 61401 / Fax 309.345.3526 Phone 309.345.3501 with ques ons or for registra on info. Meet the Sandburg Coaches Mike Bailey serves as the athle c director, women’s golf and women’s basketball coach at Carl Sandburg College. He has 20 years of coaching experience at Sandburg. Coach Bailey holds degrees from North Iowa Area Community College and University of Northern Iowa. Summer
Sports Camps
Rodney Blue was hired as the Sandburg cross country coach in February 2015. He has 25 years of coaching experience with me spent at all school and college levels. An avid runner, Blue holds high school track & field records and was inducted into the Galesburg High School Athle c Hall of Fame. Kevin Mahlan has 15 years experience as a head soccer coach. He has coached at the high school and college levels. A re red police officer, he spent 22 years on the force in Florida. Coach Mahlan holds an associate degree and a bachelor’s degree in criminal jus ce, and a master’s in curriculum and instruc on. Todd Winkler is entering his eighth year coaching the Carl Sandburg so ball team. He has 38 years experience in coaching and playing fast pitch so ball. He has also been Sandburg’s volleyball coach since 2003. Coach Winkler graduated from Western Illinois University. 2051 Tom L. Wilson Blvd. CME Building Galesburg, IL, 61401 309.345.3501 Registration Form
Corporate & Leisure College Galesburg 309.345.3501 2017 Sandburg Sports Camps
Summer Sports Camps Informa on Questions? Phone 309.345.3501 or Email [email protected]
Summer Sports Camp Informa on, con nued Parent Agreement
Summer Sports Camp Informa on, con nued We are making every effort to ensure that your child will have a posi ve experience while at Carl Sandburg College and require parental consent regarding the following: So ball Sports Camp May 31, June 1 & 2, 2017 Cross Country Sports Camp June 5, 6, 7, 8 & 9, 2017 Volleyball Sports Camp June 26, 27, 28 & 29, 2017 14 ‐ 18 year old 8:30 a.m. to 11:30 a.m. For students who have completed grades K ‐ 8 11 ‐ 13 year old 10:00 a.m. to 12:00 p.m. 11 ‐ 13 year old 1:30 p.m. to 3:30 p.m. 5:00 p.m. to 6:00 p.m. 14 ‐ 18 year old 1 :00 p.m. to 3:00 p.m. 8 ‐ 10 year old 12:30 p.m. to 2:00 p.m. Loca on: Carl Sandburg College, Main Campus Loca on: John M. Lewis Gymnasium Carl Sandburg College Main Campus Loca on: Hungate So ball Field, Carl Sandburg College, Main Campus Led by Sandburg cross country team members & Coach Rodney Blue, Carl Sandburg College Led by Sandburg so ball team members & Coach Todd Winkler, Carl Sandburg College Registra on deadline: May 24, 2017 Led by Sandburg volleyball team members & Coach Todd Winkler, Carl Sandburg College 
I agree to follow the camp check‐in/check‐out procedures established by the College. I agree to pick‐up my child promptly a er each sports camp. 
I give permission to Carl Sandburg College to video or photograph my child. I relinquish all photographic rights and give permission to Carl Sandburg College, Sandburg’s Corporate & Leisure College, and Marke ng & Public Rela ons Dept. to use my child’s likeness as they deem appropriate. 
I will not hold the College or the College personnel or agents responsible in the event of an accident or injury. 
I understand that the College is not responsible for lost or damaged property. 
I understand that College personnel are not permi ed to hold or be responsible for administering any medica on. 
I understand the College may dismiss my child from the camp for any reason that is deemed harmful or disrup ve to the other par cipants or just cause. Refunds will not be granted if a child is suspended. 
I understand that it is my responsibility to no fy the College if the student has any impairment or condi on which restricts the student’s ability to par cipate in any way. I agree to provide an aide to assist my child if the child has a condi on that requires individual assistance. 
I understand that in an emergency I will be contacted as soon as possible at the phone number(s) listed below. I have provided an alternate contact below. 
I authorize Carl Sandburg College staff to take whatever measures they deem necessary in the event of an emergency. I also give permission for my child to be given emergency treatment at a local hospital or on site. Cost: $40 & includes a t‐shirt Registra on deadline: June 14, 2017 Cost: $40 & includes a t‐shirt Registra on deadline: May 19, 2017 Cost: $40 & includes a t‐shirt Does your child have any allergies? Yes No If yes, please explain: _______________________________________________ _________________________________________________________________ Does your child have any medical condi ons? Yes No If yes, please explain: _______________________________________________ _________________________________________________________________ Golf Sports Camp June 5 & 6, 2017 Basketball Sports Camp June 19, 20, 21, 22, & 23, 2017 Soccer Sports Camp August 7, 8, 9, 10, & 11, 2017 For students who have completed grades 4 ‐ 8 For students who have completed grades 4 ‐ 9 For students who have completed grades 4 ‐ 9 9:00 a.m. to 12:00 p.m. 9:00 a.m. to 12:00 p.m. 8:30 a.m. to 12:00 p.m. Loca on: Lake Bracken, Galesburg Led by Sandburg Golf Coaching Staff & Lake Bracken Golf Staff Registra on deadline: May 24, 2017 Cost: $30 & includes a t‐shirt Loca on: John M. Lewis Gymnasium Carl Sandburg College Main Campus Led by Sandburg basketball team members & Coach Mike Bailey, Carl Sandburg College Registra on deadline: June 7 , 2017 Cost: $50 & includes a t‐shirt Career and technical programs/courses are offered without regard to race, color, na onal origin, sex, sexual orienta on, age, disability or status in any group protected
by applicable federal, state or local law. Please contact the Title IX Coordinator or ADA/Sec on 504 Coordinators with further ques ons.
Mother Name/Guardian: ____________________________________________ Business Phone: _____________________ Cell Phone: ____________________ Father Name/Guardian: _____________________________________________ Business Phone: _____________________ Cell Phone: ____________________ Loca on: Knox County YMCA, Galesburg Led by Sandburg soccer team members & Coach Kevin Mahlan, Carl Sandburg College Registra on deadline: July 26, 2017 Cost: $50 & includes a t‐shirt If I am not available, I designate the following to be contacted in an emergency. Name:___________________________________________________________ Rela onship:__________________________ Cell Phone: __________________ Other Phone: _____________________________________________________ The mission of Carl Sandburg College is to provide
all students with opportuni es for success.
I have read, understand, and agree to the above informa on: ______ (ini als)