2013 Samford Volleyball Camp Registration
2013 Samford Volleyball Camp Registration (You can also register online at www. Dexvolleyballcamps.com) Date th July 8 th July 9 th th July 8 -9 th
Time 1pm-8pm 1pm-8pm ALL SESSIONS th
July 15 -18 th th July 15 -18 th th July 15 -18 th th July 15 -18 th July 11
9am-3pm 9am-12pm 9am-12pm 9am-12pm 10am-9pm
th
10am-9pm
th
9am- to completion (3-4) ALL SESSIONS
July 12 July 13
th
th
July 11 -13
Description MiddleSchool TeamCamp1 MiddleSchool TeamCamp2 Middle School Team Camp *All Sessions* Youth Skills Camp Intro Skills Camp Volley Tots VolleyTots *All Sessions* High School Team Camp Session 1 Team Skills High School Team Camp Session 2 Competitive Play V & JV Play Day Head-to-head matches All High School Team Camps & Play Day Libero Camp Setter/Attacker Camp 1
Grades th th 6 -8 th th 6 -8 th th 6 -8 th
th
5 -9 st th 1 -5 th K -3 rd K-3 th th 9 -12 th
th
th
th
th
th
9 -12 9 -12
Cost $80 *includes meal* $80 *includes meal* $160 *includes meal each day* $250 *lunch included* $140 $20 *per day* $80 *4 sessions* $140 *two meals free & play day entry* $140 *two meals free & play day entry* $30
(X)
9 -12
$280 *meals included on Thursday & Friday* rd th th July 23 9am-3pm 7 -12 $80 *lunch included* nd th th July 22 9am-3pm 7 -12 $80 *lunch included* (limited space today) rd th th July 23 9am-3pm Setter/Attacker Camp 2 7 -12 $80 *lunch included* Setter/hitter camp is now offered two different days because it was our most popular camp last year. th th th July 24 9am-3pm Position Camp One Day 9 -12 $80 *lunch included* nd th th th July 22 -24 9am-3pm Position Camp 9 -12 $200 *lunch included* Please make checks payable to DEX VOLLEYBALL CAMPS – 800 Lakeshore Dr. Birmingham, AL 35229 RELEASE FOR MEDICAL TREATMENT & Registration CAMPERS WILL NOT BE ACCEPTED UNTIL INSURANCE INFORMATION IS PROVIDED NAME OF CAMPER:_____________________________ DOB:_____/_____/_____ PARENT NAME:________________________ DATE OF LAST IMMUNIZATION:_____/_____/_____ AGE:________ ALLERGIES:__________________________________ ANY CONDITIONS THAT PHYSICIANS SHOULD BE AWARE OF: (write on back if needed)_________________________________ EMERGENCY NUMBERS: (H) ( )____________________ (W) ( )____________________ (C) ( )____________________________ ADDRESS:___________________________________________________ CITY:____________________ STATE:____ ZIP:_______ SCHOOL:__________________________________________________ DEX’s CAMP T-SHIRT SIZE: CIRCLE ONE EMAIL:___________________________________________________ (ADULT) S M L XL (YOUTH) M L I HEREBY AUTHORIZE ANY MEDICAL TREATMENT AND TRANSPORTATION DEEMED NECESSARY TO RECEIVE THAT TREATMENT WHICH MAY BE ADVISED OR RECOMMENDED BY AN ATTENDING PHYSICIAN FOR______________________________________ (CAMPER) WHILE ATTENDING SAMFORD VOLLEYBALL CAMP. I ALSO AUTHORIZE SAID CAMPER TO PARTICIPATE IN THE ACTIVITIES OF THE CAMP, TO INCLUDE SPECIFIC SPORT ACTIVITIES AND RECREATIONAL ACTIVITIES CONDUCTED AT THE CAMP. I UNDERSTAND THAT THE CAMPER WILL ENGAGE IN PHYSICAL ACTIVITIES DURING THE PROGRAM WHICH CONTAIN AN INHERENT RISK OF PHYSICAL INJURY, AND I ASSUME THE RISK AND RELEASE SAMFORD UNIVERSITY AND ANY AGENTS OF DEX VOLLEYBALL CAMPS FROM ANY AND ALL LIABILITY FOR PERSONAL INJURY ARISING FROM THE CAMPER’S PARTICIPATION IN THE PROGRAM. I ALSO UNDERSTAND THAT THE CAMPER IS RESPONSIBLE FOR ALL PERSONAL BELONGINGS AND EQUIPMENT. SAMFORD UNIVERSITY OR DEX VOLLEYBALL CAMPS WILL NOT REPLACE OR REIMBURSE LOST OR STOLEN ITEMS.
PARENT SIGNATURE: __________________________________________ INSURANCE COMPANY:_______________________________________
DATE:_____/_____/_____ POLICY #:________________
Samford University is an equal opportunity institution and a member institution’s sports camp or clinic shall be open to any and all entrants (limited only by number, age, grade level, and/or gender.
Time 1pm-8pm 1pm-8pm ALL SESSIONS th
July 15 -18 th th July 15 -18 th th July 15 -18 th th July 15 -18 th July 11
9am-3pm 9am-12pm 9am-12pm 9am-12pm 10am-9pm
th
10am-9pm
th
9am- to completion (3-4) ALL SESSIONS
July 12 July 13
th
th
July 11 -13
Description MiddleSchool TeamCamp1 MiddleSchool TeamCamp2 Middle School Team Camp *All Sessions* Youth Skills Camp Intro Skills Camp Volley Tots VolleyTots *All Sessions* High School Team Camp Session 1 Team Skills High School Team Camp Session 2 Competitive Play V & JV Play Day Head-to-head matches All High School Team Camps & Play Day Libero Camp Setter/Attacker Camp 1
Grades th th 6 -8 th th 6 -8 th th 6 -8 th
th
5 -9 st th 1 -5 th K -3 rd K-3 th th 9 -12 th
th
th
th
th
th
9 -12 9 -12
Cost $80 *includes meal* $80 *includes meal* $160 *includes meal each day* $250 *lunch included* $140 $20 *per day* $80 *4 sessions* $140 *two meals free & play day entry* $140 *two meals free & play day entry* $30
(X)
9 -12
$280 *meals included on Thursday & Friday* rd th th July 23 9am-3pm 7 -12 $80 *lunch included* nd th th July 22 9am-3pm 7 -12 $80 *lunch included* (limited space today) rd th th July 23 9am-3pm Setter/Attacker Camp 2 7 -12 $80 *lunch included* Setter/hitter camp is now offered two different days because it was our most popular camp last year. th th th July 24 9am-3pm Position Camp One Day 9 -12 $80 *lunch included* nd th th th July 22 -24 9am-3pm Position Camp 9 -12 $200 *lunch included* Please make checks payable to DEX VOLLEYBALL CAMPS – 800 Lakeshore Dr. Birmingham, AL 35229 RELEASE FOR MEDICAL TREATMENT & Registration CAMPERS WILL NOT BE ACCEPTED UNTIL INSURANCE INFORMATION IS PROVIDED NAME OF CAMPER:_____________________________ DOB:_____/_____/_____ PARENT NAME:________________________ DATE OF LAST IMMUNIZATION:_____/_____/_____ AGE:________ ALLERGIES:__________________________________ ANY CONDITIONS THAT PHYSICIANS SHOULD BE AWARE OF: (write on back if needed)_________________________________ EMERGENCY NUMBERS: (H) ( )____________________ (W) ( )____________________ (C) ( )____________________________ ADDRESS:___________________________________________________ CITY:____________________ STATE:____ ZIP:_______ SCHOOL:__________________________________________________ DEX’s CAMP T-SHIRT SIZE: CIRCLE ONE EMAIL:___________________________________________________ (ADULT) S M L XL (YOUTH) M L I HEREBY AUTHORIZE ANY MEDICAL TREATMENT AND TRANSPORTATION DEEMED NECESSARY TO RECEIVE THAT TREATMENT WHICH MAY BE ADVISED OR RECOMMENDED BY AN ATTENDING PHYSICIAN FOR______________________________________ (CAMPER) WHILE ATTENDING SAMFORD VOLLEYBALL CAMP. I ALSO AUTHORIZE SAID CAMPER TO PARTICIPATE IN THE ACTIVITIES OF THE CAMP, TO INCLUDE SPECIFIC SPORT ACTIVITIES AND RECREATIONAL ACTIVITIES CONDUCTED AT THE CAMP. I UNDERSTAND THAT THE CAMPER WILL ENGAGE IN PHYSICAL ACTIVITIES DURING THE PROGRAM WHICH CONTAIN AN INHERENT RISK OF PHYSICAL INJURY, AND I ASSUME THE RISK AND RELEASE SAMFORD UNIVERSITY AND ANY AGENTS OF DEX VOLLEYBALL CAMPS FROM ANY AND ALL LIABILITY FOR PERSONAL INJURY ARISING FROM THE CAMPER’S PARTICIPATION IN THE PROGRAM. I ALSO UNDERSTAND THAT THE CAMPER IS RESPONSIBLE FOR ALL PERSONAL BELONGINGS AND EQUIPMENT. SAMFORD UNIVERSITY OR DEX VOLLEYBALL CAMPS WILL NOT REPLACE OR REIMBURSE LOST OR STOLEN ITEMS.
PARENT SIGNATURE: __________________________________________ INSURANCE COMPANY:_______________________________________
DATE:_____/_____/_____ POLICY #:________________
Samford University is an equal opportunity institution and a member institution’s sports camp or clinic shall be open to any and all entrants (limited only by number, age, grade level, and/or gender.
