June 16, 2018 Ages 6-17 June 16, 2018 Ages 6-17
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 16, 2018. I acknowledge that I have read the information from VSU regarding the summer Football 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 Football 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.
Cancellation and Refund Payments are non-refundable. No refunds will be given to campers who leave voluntarily or to those who are sent home for disciplinary reasons at the discretions of the camp directors.
Camp Hours & Location 9:00 a.m.-12:00 p.m. Rogers Stadium Camp registration/check in will begin at 8 a.m.
Contact Information
Phone: (804) 524–5103 Fax: (804) 524–5763 E-Mail: [email protected] [email protected]
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)
Payment Submit Checks or Money Orders to: VSU Athletics: 2018 Football Summer Camp P.O. Box 9058 Petersburg, Virginia 23806 or Call 804-524-5656 to pay by phone (Please submit application and payment together) Camp Day walk-up payments (cash only) are welcome!
June 16, 2018 Ages 6-17
Please check the applicable session your camper will be attending.
Defensive and Offensive Line Camp June 16, 2018 9 a.m.-12 p.m. Ages 6-17 (not open to high school graduates) Camp Cost: $25 Per Camper
What to Bring Participants are asked to bring a towel, snack, water bottle, and any other personal football attire.
2018 Football Summer Camp Application Please return this competed form along with a check or money order made payable to “VSU Football 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:__________________ In case of an emergency, if parent/ guardian cannot be reached please list contact person that can act on your behalf.
7-on-7 Team Camp June 16, 2018 9 a.m.-12 p.m. Ages: High School Teams (not open to high school graduates) Camp Cost: $120 Per Team
Emergency Contact:______________________ Relationship:____________________________ (H)__________(C)___________(W)_________ Please list any medical condition or medication that camp staff should be aware of:___________ ________________________________________ ________________________________________
Cancellation and Refund Payments are non-refundable. No refunds will be given to campers who leave voluntarily or to those who are sent home for disciplinary reasons at the discretions of the camp directors.
Camp Hours & Location 9:00 a.m.-12:00 p.m. Rogers Stadium Camp registration/check in will begin at 8 a.m.
Contact Information
Phone: (804) 524–5103 Fax: (804) 524–5763 E-Mail: [email protected] [email protected]
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)
Payment Submit Checks or Money Orders to: VSU Athletics: 2018 Football Summer Camp P.O. Box 9058 Petersburg, Virginia 23806 or Call 804-524-5656 to pay by phone (Please submit application and payment together) Camp Day walk-up payments (cash only) are welcome!
June 16, 2018 Ages 6-17
Please check the applicable session your camper will be attending.
Defensive and Offensive Line Camp June 16, 2018 9 a.m.-12 p.m. Ages 6-17 (not open to high school graduates) Camp Cost: $25 Per Camper
What to Bring Participants are asked to bring a towel, snack, water bottle, and any other personal football attire.
2018 Football Summer Camp Application Please return this competed form along with a check or money order made payable to “VSU Football 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:__________________ In case of an emergency, if parent/ guardian cannot be reached please list contact person that can act on your behalf.
7-on-7 Team Camp June 16, 2018 9 a.m.-12 p.m. Ages: High School Teams (not open to high school graduates) Camp Cost: $120 Per Team
Emergency Contact:______________________ Relationship:____________________________ (H)__________(C)___________(W)_________ Please list any medical condition or medication that camp staff should be aware of:___________ ________________________________________ ________________________________________
