2017 vsu women's basketball vsu women's basketball summer camp

Permission to Participate & Informed Consent – Summer Camp I understand that my child, __________________ will be participating in summer camp at Virginia State University (“VSU”) on June 19-22, 2017. I acknowledge that I have read the information from VSU regarding the summer Women’s Basketball camp. I understand that my child will be participating in this summer camp with other students, non-members and volunteers from the VSU community. By signing this Consent Form and Release, I declare that I have legal custody and/or guardianship of _________________, a minor, and that I consent to allow _______________ to participate in the summer Women’s Basketball camp. Activities will include, but not be limited to: skills, basic fundamental drills, lecture and competition. I understand that participation in this activity is strictly voluntary. I have read, understand, and have discussed with my child that: A. Participants are expected to follow instructions of coaches, volunteers and other individuals that are overseeing the camp. B. Participants are expected to fully participate in activities outline by the adults/person in charge of events and activities, unless parent/guardian has made prior arrangements. C. Participants are expected to respect each other, equipment/ materials that are made available to them, and in charge of the event. I have discussed with my child the importance of following directions and safety procedures that will be outlined by the coaches and volunteers in charge of the activity. I understand that my child is not required to participate in this activity, but grant permission for him/her to do so, despite the possible risks. I understand that the personal information collected by VSU will not be disclosed to any third parties for any purpose. I recognize that by participating in this activity my child may risk personal injury. I hereby attest and verify that I have been advised of the potential risks, that I am fully knowledgeable of the risks involved in this activity, and that I assume any expenses that may be incurred in the event of accident, illness, or other incapacity, regardless of whether I have authorized such expenses. Signed:___________________________Date:__________ (Parent/Guardian) Signed: ___________________________ Date:__________ (Participant)

Cancellation and Refund Your deposit will be refunded, less a $30 charge, if notification is not received one week prior to the start date of camp. Refunds after that date, less $30, will be made for medical reasons upon receipt of a letter from a certified physician. No refunds will be given to campers who leave vol-untarily or to those who are sent home for disciplinary reasons at the discretions of the camp directors. Camp Cost: $100 Per Camper Camp Hours & Location June 19-22, 2017 9:00 a.m.-5:00 p.m. Multipurpose Center Camp registration/check in will begin at 8:00 a.m. What to Bring Participants are asked to bring a towel, lunch, water bottle, and any other personal basketball needs. Contact Information Phone: (804) 524–5784 Fax: (804) 524–5763 E-Mail: [email protected] [email protected] Payment Submit Checks or Money Orders to: VSU Athletics: 2017 Women’s Basketball Summer Camp P.O. Box 9058 Petersburg, Virginia 23806 or Call 804-524-5656 to pay by phone (Please submit application and payment together)

2017 VSU WOMEN’S BASKETBALL SUMMER CAMP June 19-22, 2017 Age: 7-16

Camp I : FUNDAMENTALS This four day camp focuses on individual development, teamwork and sportsmanship. Our staff will teach sound basketball fundamentals for be-ginners, provide a competitive environment for more advanced players, and give players the skills and knowledge necessary to become a complete player. Our camp will be filled with plenty of basketball skill development and lots of fun. Virginia State University invites you to become a part of what promises to be an enjoyable and exciting week of basketball. Date: June 19-22,2017 Time: 9:00 a.m. - 5:00 p.m. Cost : $100.00 (Includes T–Shirt ) Daily Schedule: 9:00 a.m.…………………Roll Call & Stretching 9:30 a.m.…………………...Dribbling & Passing 10:30 a.m.……………...Individual Development 11:30 a.m……………..…Fundamental Shooting Noon………………………………..…….Lunch 1:00 p.m..………………..Drills & Fundamentals 2:00 p.m…………………...…….3 on 3 & 5 on 5 3:30 p.m………………….....…..…. Free Throws 4:30 p.m……….……..….. Cool Down & Stretch 4:45 p.m……….....Announcements & Dismissal

2017 Women’s Basketball Summer Camp Application Please return this competed form along with a check or money order made payable to “VSU Women’s Basketball Camp” Camper’s Name: ________________________ Team Name: ____________________________ School:________________________________ Grade Entering Fall:_______ Age:__________ Primary Parent or Guardian Name: ______________________________________ Address:_______________________________ City/State/Zip:__________________________ Parent’s E-Mail Address:__________________ Parent’s Contact Number:__________________ T-Shirt Size (Circle One): Adult/Youth S M L XL In case of an emergency, if parent/ guardian cannot be reached please list contact person that can act on your behalf. Emergency Contact:______________________ Relationship:____________________________ (H)__________(C)___________(W)_________ Please list any medical condition or medication that camp staff should be aware of:___________ ________________________________________ ________________________________________