Hampden-Sydney Home PageHampden-Sydney Athletics
Monday, October 13, 2008
SUMMER LACROSSE CAMPS 2009

Lacrosse Performance School
Rising 9th through Pre-College

Sunday, July 12 - Wednesday, July 15, 2009
Sunday, July 26 – Wednesday, July 29, 2009

 Advanced Instruction by College Coaches

Shooting!   Face-offs!  Goalie Play!  Individual Defense!

Directors and Lead Instructors

Shooting:  Jason Rostan, H-SC 2003 and Assistant Coach, 1st Team All-American and ODAC Player of the Year

Face-offs:  Jake Plunket, Asst. Coach H-SC, 2005 Syracuse University and member of the 2008 Rochester Rattler MLL Championship

Defense:  Mike Plantholt, Head Coach, Randolph-Macon College,   National Defenseman of the Year and 1st Team All-American

Goalie Play:  Scott Ketcham, Head Coach, Randolph College, 1999 NCAA Statistical Leader while at H-SC              

Camp director Ray Rostan is the Head Coach at Hampden-Sydney College, since 1984. Coach Rostan was named the National Coach of the Year in 1989 and 1998.  He was the defensive coordinator for the 2002 USA World Championship Team, a former  member of the 1974 NLL Rochester Griffins Pro Indoor Championship team, and played on the 1973 D-III National Championship team as an attack- man while at Cortland State.


Hellmuth-Pritzlaff Lacrosse Stadium, a new state of the art Field Turf field, will be on of the great fields utilized by our campers

Featuring

  • "State of the Art" Field Turf & Bermuda Fields
  • Small group instruction by College Coaches and former All-Americans
  • Air-conditioned Dormitories & Dining Facilities
  • Great game competition

Print the following application or request a hard copy of our brochure.

Printer-friendly version of application

Performance School Application At Hampden-Sydney College

Choose Session:

Last Name_______________________  First Name____________________________

Parent E-mail ___________________________________________________________

Secondary E-Mail________________________________________________________

Street Address__________________________________________________________

Town or City___________________________________    State____    Zip__________

Telephone(      )___________________    Year in School 2009-2010 ________________

High School or Club______________________    Coach's name_____________________

Lacrosse Position___________________   

Roommate Request:

(1st Choice )_____________________ (2nd Choice)______________________
You must both request each other. We cannot guarantee that you will be in the same room as all friends, yet we will place you as close together as possible.

***Please return this form with the $410 overnight camper fee or $250 non-refundable deposit with a balance of $160 and a separate key & damage deposit check for $60 refundable when room key is returned. Mail to: Ray Rostan, Performance School, 1001 Meadowview Lane, Farmville, VA 23901. Checks Payable To: Ray Rostan-Performance School (due by July 1, 2009)

PARENTAL STATEMENT:

I hereby verify that my child is physically fit to play the contact sport of Lacrosse. In addition, I authorize any emergency treatment deemed necessary for my child to be administered by the provided medical staff and agree not to hold the medical staff, Hampden-Sydney College, the coaches, or the Hampden-Sydney Performance School staff liable for any injuries.

Parent Signature:_________________________________________    Date__________________

 

MEDICAL CONSENT FORM

Camper's Name__________________________________    Social Sec.#____________________

                                                                                        Birth date_____________________

If an emergency arises, list two people who can be notified:

Name____________________________________    Name________________________________

Relationship______________________________    Relationship___________________________

Phone: Home (    )_________________________    Phone: Home (    )______________________

Phone: Work (    )__________________________    Phone: Work (    )______________________

Does the applicant have any known allergies to food or medication?

 Yes   No

If yes, please list the foods and/or drugs:

Give date of the latest DPT or Tetanus Toxoid injection:_________________________________

 

Does the applicant have any ongoing disease, physical disability or recurring illness that may affect or impair participation in the Hampden-Sydney Performance School?

Yes   No

If yes, please attach a physician?s note describing the disability and specific limitation for participation.

 

Is the applicant covered by medical insurance? (mandatory as all camp insurance is supplemental)

Yes   No

Please list the following:

Name of Insurance Company:__________________________    Policy #____________________

Address____________________________________________    Phone (     )_________________

 

PARENTAL CONSENT FOR TREATMENT OF MINORS 
Please mail in advance

Parental permission must be obtained before medical treatment can be rendered to a person under 18 years of age. Please read and sign the following consent. No major procedures will be performed except in extreme emergency, without parents being fully informed. Please note that your child may not participate in the Hampden-Sydney Performance School until we receive the signed Parent Consent form.

I GIVE PERMISSION TO THE HAMPDEN-SYDNEY PERFORMANCE SCHOOL ATHLETIC TRAINER TO CARRY OUT SUCH EMERGENCY DIAGNOSTIC AND THERAPEUTIC PROCEDURES AS MAY BE NECESSARY FOR MY SON AND IN THE PHYSICIANS? ABSENCE FOR THE ATHLETIC TRAINER ON DUTY TO RENDER EMERGENCY CARE IN LINE WITH STANDING ORDERS, AND ALSO PERMIT SUCH PROCEDURE TO BE CARRIED OUT AT AND BY ONE OF THE LOCAL HOSPITALS IN THE EVENT THAT MY SON HAS BEEN SENT OR TAKEN THERE FOR EMERGENCY CARE.

 SIGNED:____________________________________________    RELATIONSHIP_______________

                                                                                              DATE______________________

Last modified: 9-8-2008