Parent Consent, Waiver, and Release Form PARTICIPANT’S NAME

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In consideration of the Soccer Program’s acceptance of the camper named above as a participant in the Clinic for the period in the dates mentioned above, and in return for the opportunity to participate in this camp: It is agreed that all risks attendant to watching and/or participating in camp activities, including, but not limited to bodily injury, are assumed by the student and the student’s parent(s) and/or legal guardian(s), and that this assumption is acknowledged, approved, and agreed to by said student and parent(s) and/or legal guardian(s) as indicated by the signature hereto. I hereby certify that the above named camper is physically able to participate in the John Carroll University Men’s Soccer Clinic, and that I know of no physical impairments which would in any manner limit his/her participation in such a program. I hereby grant permission for physicians, dentists, other licensed health care providers and their designees employed by John Carroll University to administer outpatient medical, surgical, or dental services as appropriate, or necessary antigens or other injections, to perform emergency procedures as necessary or to refer to duly licensed medical personnel when indicated. In consideration for honoring my child’s request to participate in the above activity, I, for myself, my executors, administrators, and assigns, do hereby release and forever discharge John Carroll University, and its Board of Trustees, its respective entities, administrators, faculty members, employees, agents, and students from any claims that I might have myself or could bring on my child’s behalf with regard to damages, demands, or any actions whatsoever, including those based on negligence or failure to supervise, in any manner arising out of my child’s participation in this activity. I also hereby agree to save, hold harmless, and indemnify The John Carroll University, its Board of Trustees, and/or its respective entities, administrators, faculty members, employees, agents, and students against any and all claims, including claims of negligence Men’s Soccer Clinic ­­– Stadium or failure to supervise, which my child might bring against them as a result of his or her participation in the above activity. I recognize that this Release means Saturday, June 19 that I am giving up, among other things, rights to sue the University or its Board of Trustees, its respective entities, administrators, faculty members, employees, agents or students for injuries, damages or losses that my child may incur.

Medical Information Medical Insurance Company______Address______City______State______Zip_____ Phone______Group # I.D.#______Medical History (if pertinent):______Allergies, present medications, special considerations:______

Parent/Guardian Information Name______Address______City______State______Zip_____ Phone______John Carroll University 20700 North Park Boulevard Emergency Contact Information University Heights, 44118 Name______Relationship______www.jcu.edu Home Phone______Cell Phone______Email______

Name______Relationship______Home Phone______Cell Phone______Email______John Carroll University Men’s Soccer Clinic — Don Shula Stadium Saturday, June 19 John Carroll University Dejan Mladenovic Men’s Soccer Clinic ­­– Don Shula Stadium • A four year graduate assistant of the John Carroll The clinic is designed for student athletes men’s soccer program. entering grades 9 – 11. Saturday, June 19 • A former four-year letter winner and 2006 graduate of (Please fill out completely including reverse side) John Carroll with a degree in business management. 9:00 – 9:30 am, Check-in 9:30 am – Noon, Technical & Tactical Training • Mladenovic manages the Force Soccer programs and Name______merchandising in the area. Noon – 1:30 pm, Lunch provided in the JCU Schott Dining Hall Address______1:30 – 4:00 pm, Inter-squad scrimmages • The OAC Co-Midfielder of the Year in 2005, helping lead the Blue Streaks to the conference regular season City______and tournament titles leading to an NCAA Division III State______Zip______The clinic is designed for student athletes entering grades 9 – 11 Championship appearance. and directed by Hector Mariano and Dejan Mladenovic. • As a senior, Mladenovic led all players in the OAC in Phone______Home Phone______goals (8) and points (18) during the regular season Cell Phone______conference schedule, finishing with 11 goals and 26 Hector Marinaro points on the season. Email Address______• Over the course of his career in which he played a Parent Email Addres______• The all-time leading scorer in Major Indoor Soccer program record 80 games, Mladenovic tallied 19 goals Previous Experience______League (MISL) history with 1,223 goals and 701 assists and 13 assists for 51 points. in a 21-year career. ______

• A 9 time MISL scoring champion. Present Grade______T-shirt Size______• Played 16 seasons with the franchise.

• In his final 2 seasons with the Cleveland Force (2002- Return registration form and check payable to 04), Marinaro doubled as a player and assistant coach. Please direct any questions to Dejan Mladenovic at “John Carroll University” in the amount of $75 per participant by June 15 and mail to: • With a career that included being named to 15 all- [email protected] or call (440) 503-3996. star teams and leading Cleveland to three league Men’s Soccer championship titles in the 1990’s, the MISL League $75 per participant John Carroll University Most Valuable Player Award was named the Hector 20700 North Park Boulevard Marinaro MVP Award in 2005. University Heights, Ohio 44118 • He has led the Blue Streaks to a record of 36-29-13 in Return registration form and check payable to four seasons and secured the 5th OAC Championship “John Carroll University” by June 15 and mail to: Please direct any questions to Dejan Mladenovic at [email protected] or call (440) 503-3996. title in the programs history. • A native of Mississauga, Canada, Marinaro also played Men’s Soccer nine seasons with the Toronto Blizzard of the Canadian John Carroll University Soccer League. Parent/Legal Guardian Signature 20700 North Park Boulevard • Has been a member of the Canadian National Team, University Heights, Ohio 44118 most recently in 2002. Signature ______

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