2 Day High Performance Skills Cricket Clinic for Ages 10 - 18 years Sunday 18th & Monday 19th December 2016 Monarch High Performance Academy in conjunction with GAP Resource Management and Fortitude Human Performance presents a unique opportunity for Junior Cricketers to receive Elite Level Coaching from Mark Higgs and Andrew Dawson during December to build on your 2016-17 Cricket Season. Specialist Cricket Coaches & Tacticians Mark Higgs and Andrew Dawson are High Performance Coaches, each bring over 20 years’ experience both in a playing and a coaching capacity. Mark has had coaching experience with the Prime Ministers XI and was a member of the Cricket Australia National Spin Bowling panel. Mark has played for the Australian One Day Squad, Australia A, New South Wales, South Australia, Hobart Hurricanes in T20 Big Bash League 2 and ACT Comets as the Captain. High Performance Specialists Elite Training, Tactics & Strategies Andrew was the Head Fast Bowling Coach for Cricket ACT on the Cricket Australia panel and also coached the ACT Meteors for four seasons with the highlight of coming runners-up in the Cricket Australia Women’s National League T20 competition. Andrew is a Cricket NSW contracted specialist coach. Together, Mark and Andrew have developed and managed a number of Australian male first class players such as Jason Behrendorff, Ryan Carters, Nathan Lyon and Alex Ross and most recently with Australian female first class players such as Rene Farrell and Erin Osborne. MONARCH HIGH PERFORMANCE ACADEMY Mark and Andrew were the former co-coaches of the ACT Comets program when they won the Cricket Australia Cup. Mobile: 0410 628 001 Email: [email protected] Take your game to the next level CLINIC REGISTRATION FORM Sunday 18th & Monday 19th December 2016 Berrambool Sports Centre & Grounds, Berrambool Drive, Merimbula 930am to 330pm daily Proudly brought to you by GAP Resource Management & Fortitude High Performance Inclusions & Player Details Specialist Coaches delivering High Performance Cricket Coaching throughout each day; Day One Registration at 9am with fruit and refreshment provided daily. Each participant will be required to bring their own full cricket kit (including helmet and all protective equipment) and wear appropriate cricket clothing. Each participate is responsible for their own lunch and snacks. Player Name (Please complete a form per player) Player Address Parent/Guardian Email Address Parent/Guardian Contact Details Home Phone Mobile Phone Medicare Number & Position on Card Health Insurance Provider Insurer Membership Number Do you have Ambulance Cover? (Please confirm) Age Band & Team/Division for 2016-17 season Cricket role (Batter, Bowler/type, Wicket Keeper) Highest Cricket Level achieved to date Name of Next of Kin/Emergency Contact Person Home Phone Mobile Phone Next of Kin/Emergency Contact Details Payment Details & Consent Price is $200 per person for the 2 (two) days or $115 per person per day. I will transfer a total of $_______________ for ______________ days (please list total number of days) into the below account: Account Name Monarch High Performance Academy National Australia Bank BSB 082 968 Account Number Details 91 402 8982 Number of Days Attending (please tick to confirm) Day 1 Sunday 18th Dec Day 2 Monday 19th Dec To be completed by Parent or Guardian and Player I/We (parent/guardian) of _________________________________ give staff/coaches of Monarch High Performance Academy permission to obtain Medical and/or Emergency Care as deemed necessary. I/we will be responsible for all costs incurred for medical and/or emergency care. Every reasonable effort will be made to contact the parent(s)/guardian(s) or the Next of Kin/Emergency Contact person using the contact details provided above. Name:____________________________Signed: __________________________________ (parent/guardian 1) Date: _________________ Name:____________________________Signed: __________________________________ (parent/guardian 2) Date: _________________ Name:____________________________Signed: __________________________________ (attending player) Date: _________________ PLEASE EMAIL YOUR RESIGRATION AND CONFIRMATION OF ATTENDANCE TO: [email protected] In the event of inclement weather, Monarch High Performance Academy will make every effort to provide access to an appropriate alternate venue. If the clinic is cancelled due to extreme weather or other unforeseen circumstances, refunds will not be issued, however, a credit note equal to the value of the cancelled clinic (minus a $30 administration fee) will be provided for use at a future clinic or for one-on-one coaching sessions to the value of a one (1) hour session per cancelled day. This may be transferred to another child. Note, if your child is unable to attend the clinic (either partially or fully) due to illness, individual arrangements can be made, providing a valid medical certificate is supplied. .