2014 Samford Volleyball Camp Registration
2014 Samford Volleyball Camp Registration (You can also register online at www. Dexvolleyballcamps.com) Date July 7th July 8th July 9th July 7th- 9th July 10th July 11th July 12th July 10th12th July 13th July 14th July 15th July 21st 24th July 21st24th July 21st24th July 21st24th
Time 12 pm- 8 pm 12 pm- 8 pm 12 pm- 8pm 12 pm- 8 pm 12 pm- 8 pm 12 pm- 8 pm 8 am- ??? All Sessions
Grades 6th-8th 6th-8th 6th-8th 6th-8th 9th-12th 9th-12th 9th-12th 9th-12th
6 pm- 9 pm 9 am- 3 pm 9 am- 3 pm 9 am- 12 pm
Description Middle School Team Camp 1 Middle School Team Camp 2 Middle School Team Camp 3 Middle School Team Camp High School Team Camp 1 High School Team Camp 2 High School Team Play Date High School Team Camps & Play Date All Positions Evening Camp** All Positions Camp Setter/Attacker Camp Volley Tots
Cost $80 *includes meal* $80 *includes meal* $80 *includes meal* $240 *includes meals* $140 *includes meal* $140 *includes meal* $40 *includes lunch* $280 (includes meals on
9th-12th 7th-12th 7th-12th K-3rd
$20 $80 *includes lunch* $80 *includes lunch* $20 *per day*
9 am- 12 pm
Volley Tots
K-3rd
$80 *All Sessions*
9 am- 12pm
Intro Skills Camp
1st-5th
$140
9 am- 3 pm
Youth Skills Camp
5th-9th
$250 *includes meal*
(X)
Thursday and Friday)
**No Online Registration; email [email protected] for more information 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: __________________________________________ DATE:_____/_____/_____ INSURANCE COMPANY:_______________________________________ 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 12 pm- 8 pm 12 pm- 8 pm 12 pm- 8pm 12 pm- 8 pm 12 pm- 8 pm 12 pm- 8 pm 8 am- ??? All Sessions
Grades 6th-8th 6th-8th 6th-8th 6th-8th 9th-12th 9th-12th 9th-12th 9th-12th
6 pm- 9 pm 9 am- 3 pm 9 am- 3 pm 9 am- 12 pm
Description Middle School Team Camp 1 Middle School Team Camp 2 Middle School Team Camp 3 Middle School Team Camp High School Team Camp 1 High School Team Camp 2 High School Team Play Date High School Team Camps & Play Date All Positions Evening Camp** All Positions Camp Setter/Attacker Camp Volley Tots
Cost $80 *includes meal* $80 *includes meal* $80 *includes meal* $240 *includes meals* $140 *includes meal* $140 *includes meal* $40 *includes lunch* $280 (includes meals on
9th-12th 7th-12th 7th-12th K-3rd
$20 $80 *includes lunch* $80 *includes lunch* $20 *per day*
9 am- 12 pm
Volley Tots
K-3rd
$80 *All Sessions*
9 am- 12pm
Intro Skills Camp
1st-5th
$140
9 am- 3 pm
Youth Skills Camp
5th-9th
$250 *includes meal*
(X)
Thursday and Friday)
**No Online Registration; email [email protected] for more information 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: __________________________________________ DATE:_____/_____/_____ INSURANCE COMPANY:_______________________________________ 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.
