Kicking Academy

Saturday, July 10, 2010

9:00 AM –12:00 Noon

Growney StadiumSt. John Fisher College

3690 East AvenueRochester, New York

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-./-0.12 Kicking Academy Registration Form

Name _______________________________________________

Date of Birth ___________________________ Age ________

Address _____________________________________________

City _______________________ State ______Zip __________

Email _______________________________________________

School ______________________________________________

Grade in School _________________ Position _____________

Parent/Guardian Name _______________________________

Home Phone_________________________________________

Work Phone _________________________________________

Email _______________________________________________

Health Insurance Carrier ______________________________

Policy Number _______________________________________No one will be allowed to participate in the KICK IT! Kicking Academy without valid Health Insurance information.

We (I) hereby give permission for the above mentioned to participate in the 2010 KICK IT! Kicking Academy on Saturday, July 10, 2010. We (I) hereby waive and release Camp Good Days and Special Times, Inc.; St. John Fisher College; and all their volunteers and staff involved, of any liability or claim in association with anything that may occur while my child is participating in the KICK IT! Kicking Academy. We (I) hereby also grant permission for the above mentioned to participate in any audio-visual event that may take place in regards to KICK IT! Kicking Academy and release Camp Good Days and Special Times, Inc.; St. John Fisher College; and everyone involved of any liability or claims in association with media coverage, if such takes place.

KICK IT!KICK IT!KICK IT!

Participant Signature (18 or older)

___________________________________ Date ____________

Parent/Guardian Signature (if under 18)

___________________________________ Date ____________

Please return completed forms, with payment to:Camp Good Days & Special Times

Attention: KICK IT! Kicking Academy1332 Pittsford-Mendon Road, PO Box 665

Mendon, NY 14506Fax to: 585-624-5799

Register online: www.campgooddays.org

Payment Information: $100.00 per participant!"Check Enclosed (payable to Camp Good Days)!"Please Charge My: ___Visa ___MasterCard ___AMEXCredit Card Number ____________________________________Exp. Date ______________________________________________Cardholder Signature___________________________________

345607859.:Gary Mervis is entering his 21st season as the Kicking & Punting Coach at St. John Fisher College. He has helped to develop several All-American kickers for the Cardinals and was inducted into St. John Fisher College’s Athletic Hall of Fame in 2007. Mervis is also the Chairman & Founder of Camp Good Days and Special Times, a 501(c)3 not-for-profit

organization dedicated to improving the quality of life for children, adults and families whose lives have been touched by cancer and other life threatening challenges. Since its inception 31 years ago, Camp Good Days has served more than 42,000 campers from 22 states and 25 foreign countries and has received the coveted Four Star Rating from CharityNavigator.org.

:18980/;5.:1.8Steve Christie spent 15 years as a place kicker in the NFL with the Tampa Bay Buccaneers, the Buffalo Bills, the San Diego Chargers, and the New York Giants. Steve set the record for longest field goal in Super Bowl history (54 yards) and was an All-American punter at William & Mary. Steve is also a talented artist who has donated several pieces of

artwork, as well as proceeds from his art sales, to help support the programs and services at Camp Good Days.

Kicking Academy-./-0.12 Kicking Academy is open to Modified, Junior Varsity, Varsity, and College level place kickers and punters. KICK IT! will be facilitated by Steve Christie, former NFL Place Kicker with the Buffalo Bills, San Diego Chargers, and New York Giants; and Gary Mervis, Kicking & Punting Coach at St. John Fisher College and Chairman & Founder of Camp Good Days and Special Times.

-./-0.12 Kicking Academy will include a variety of drills and skill advancement for both kickers and punters. Participants will receive top quality, personal instruction and guidance, to help them improve their techniques. Participants will also have the opportunity to obtain information and ask questions about off-season and pre-season conditioning, strength training and overall preparation.

-./-0.12 Kicking Academy participants will each receive a KICK IT! Instructional DVD and KICK IT! T-Shirt.

The registration cost for the KICK IT! Kicking Academy is a $100.00 donation to Camp Good Days, per participant.

KICK IT!KICK IT!KICK IT!