Team Camp
2014 Camp Application
2014 MEDICAL RELEASE FORM Complete and return this form with camp application. Consent to Medical Treatment & Release of Liability: (Read this before signing below) In consideration of being allowed to participate in this camp, related events, and activities, I hereby RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE University of Southern California Board of Trustees and their officers, agents, or employees , the State of California, Andy Enfield, this camp, and its directors and employees (hereinafter referred to as RELEASEE) from any and all liability, claims, demands, or course of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me/my child, or to any property belonging to me/my child, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEE, or otherwise, while participating in this camp, or while in, on upon the premises where the camp is being conducted. To the best of my knowledge, I/my child and/is in good physical condition and I am not aware of any physical infirmity which would place me/my child at risk to participate in any way with camp activities. I am fully aware of risks and hazards connected with the camp. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISK OF LOSS, PROPERTY DAMAGE OR PERSONAL INJURY, INCLUDING DEATH, that may be sustained by me/my child, or any loss or damage to property owned by me/my child, as a result of being engaged in the camp’s activities, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEE or otherwise. I further hereby AGREE TO INDEMNIFY AND HOLD HARMLESS the RELEASEE from any loss, liability, damage or cost, including court costs and attorney’s fees, that may accrue related to me/my child’s participation in this camp, WHETHER CAUSED BY NEGLIGENCE OF THE RELEASEE or otherwise. During the period of the camp, I hereby give permission for the staff of the University of Southern California to administer appropriate medical attention to me/my child in the event of an accident, illness or injury. I will be responsible for any and all costs of medical coverage and treatment provided not covered by insurance. It is my express intent that this Waiver of Liability and Hold Harmless Agreement shall bind the member of my family and spouse, if I am alive, and my heirs, assigns a personal representative, if I am deceased, and shall be deemed as a RELEASE, WAIVER, DISCHARGE AND COVENANT NOT TO SUE the above-named RELEASEE. I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be construed in accordance with the laws of the State of California. In signing this release, I acknowledge and represent that I have read and understand it and sign it voluntarily; I am at least eighteen (18) years of age and fully competent; and I execute this Release for full, adequate and complete consideration fully intending to be bound by the same. I HAVE READ THIS WAIVER OF LIABILITY AND FULLY UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. Signature: __________________________________________________
All players must complete Campers Name: ____________________________ Address:
____________________________
City, State, Zip:
____________________________
Phone:
___________________________
School:
____________________________
Grade (entering Fall 2014) _______ Height: _________ Email Address:
Age: ______
Weight: _________
____________________________
Adult T-Shirt Size:
XXL XL
L
M
(circle one)
Parent / Guardian Information Name:
____________________________
Home Phone:
____________________________
Cell Phone:
____________________________
Address:
____________________________
City, State, Zip:
____________________________
Email:
____________________________
Team Camp June 21-22, 2014
Parent/Guardian: ____________________________ Date: ___________ Campers Name: ______________________________________________ Medical Insurance Company Name: _____________________________
Detach and send this application, your medical release form and a copy of your family’s insurance card to:
Policy Number: ___________________________Group #: ___________ Insurance Company Phone #: __________________________________ Insured’s Name: _____________________________________________
IMPORTANT NOTE A photo copy of your insurance card must be attached to camp registration form. Applications will not be processed without.
USC Men’s Basketball Attention: Team Camp 2014 3400 S. Figueroa St Los Angeles, CA 90089
Held at the Galen Center at The University of Southern California Team camp is open to any and all campers in grades 9-12
Camp Details
2014 Camp Application Head coaches must complete
USC Head Coach Andy Enfield and the USC coaching staff look forward to watching you play!
——————————————————————————
$400 Team Registration– Limited to 12 players and 3 coaches. (Any additional player will cost $35 per player)
4 games for the weekend (2 games on Saturday, June 21 and 2 games on Sunday, June 22nd)
Large Varsity, Small Varsity, and Junior Varsity leagues
Arrange your own meals and lodging
Two 20 minute halves - clock stops last two minutes of game and last minute of first half
Games officiated by certified referees
Make Checks Payable to All Net Basketball
High School____________________________ Address:____________________________ City, State, Zip:____________________________ Phone: ___________________________ Coach ____________________________ Email Address________________________ Level: Check One Large Varsity_______ Small Varsity_____ Junior Varsity _________ Coach T-Shirt Size:
USC Campus
XXL
XL
L
M
Detach and send a check made out to ALL NET BASKETBALL USC Men’s Basketball Attention: Chris Capko 3400 S. Figueroa St Los Angeles, CA Questions: Call Chris Capko (213) 379-2296
Contact Us Call: 213-379-2296 Email: [email protected]
2014 MEDICAL RELEASE FORM Complete and return this form with camp application. Consent to Medical Treatment & Release of Liability: (Read this before signing below) In consideration of being allowed to participate in this camp, related events, and activities, I hereby RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE University of Southern California Board of Trustees and their officers, agents, or employees , the State of California, Andy Enfield, this camp, and its directors and employees (hereinafter referred to as RELEASEE) from any and all liability, claims, demands, or course of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me/my child, or to any property belonging to me/my child, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEE, or otherwise, while participating in this camp, or while in, on upon the premises where the camp is being conducted. To the best of my knowledge, I/my child and/is in good physical condition and I am not aware of any physical infirmity which would place me/my child at risk to participate in any way with camp activities. I am fully aware of risks and hazards connected with the camp. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISK OF LOSS, PROPERTY DAMAGE OR PERSONAL INJURY, INCLUDING DEATH, that may be sustained by me/my child, or any loss or damage to property owned by me/my child, as a result of being engaged in the camp’s activities, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEE or otherwise. I further hereby AGREE TO INDEMNIFY AND HOLD HARMLESS the RELEASEE from any loss, liability, damage or cost, including court costs and attorney’s fees, that may accrue related to me/my child’s participation in this camp, WHETHER CAUSED BY NEGLIGENCE OF THE RELEASEE or otherwise. During the period of the camp, I hereby give permission for the staff of the University of Southern California to administer appropriate medical attention to me/my child in the event of an accident, illness or injury. I will be responsible for any and all costs of medical coverage and treatment provided not covered by insurance. It is my express intent that this Waiver of Liability and Hold Harmless Agreement shall bind the member of my family and spouse, if I am alive, and my heirs, assigns a personal representative, if I am deceased, and shall be deemed as a RELEASE, WAIVER, DISCHARGE AND COVENANT NOT TO SUE the above-named RELEASEE. I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be construed in accordance with the laws of the State of California. In signing this release, I acknowledge and represent that I have read and understand it and sign it voluntarily; I am at least eighteen (18) years of age and fully competent; and I execute this Release for full, adequate and complete consideration fully intending to be bound by the same. I HAVE READ THIS WAIVER OF LIABILITY AND FULLY UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. Signature: __________________________________________________
All players must complete Campers Name: ____________________________ Address:
____________________________
City, State, Zip:
____________________________
Phone:
___________________________
School:
____________________________
Grade (entering Fall 2014) _______ Height: _________ Email Address:
Age: ______
Weight: _________
____________________________
Adult T-Shirt Size:
XXL XL
L
M
(circle one)
Parent / Guardian Information Name:
____________________________
Home Phone:
____________________________
Cell Phone:
____________________________
Address:
____________________________
City, State, Zip:
____________________________
Email:
____________________________
Team Camp June 21-22, 2014
Parent/Guardian: ____________________________ Date: ___________ Campers Name: ______________________________________________ Medical Insurance Company Name: _____________________________
Detach and send this application, your medical release form and a copy of your family’s insurance card to:
Policy Number: ___________________________Group #: ___________ Insurance Company Phone #: __________________________________ Insured’s Name: _____________________________________________
IMPORTANT NOTE A photo copy of your insurance card must be attached to camp registration form. Applications will not be processed without.
USC Men’s Basketball Attention: Team Camp 2014 3400 S. Figueroa St Los Angeles, CA 90089
Held at the Galen Center at The University of Southern California Team camp is open to any and all campers in grades 9-12
Camp Details
2014 Camp Application Head coaches must complete
USC Head Coach Andy Enfield and the USC coaching staff look forward to watching you play!
——————————————————————————
$400 Team Registration– Limited to 12 players and 3 coaches. (Any additional player will cost $35 per player)
4 games for the weekend (2 games on Saturday, June 21 and 2 games on Sunday, June 22nd)
Large Varsity, Small Varsity, and Junior Varsity leagues
Arrange your own meals and lodging
Two 20 minute halves - clock stops last two minutes of game and last minute of first half
Games officiated by certified referees
Make Checks Payable to All Net Basketball
High School____________________________ Address:____________________________ City, State, Zip:____________________________ Phone: ___________________________ Coach ____________________________ Email Address________________________ Level: Check One Large Varsity_______ Small Varsity_____ Junior Varsity _________ Coach T-Shirt Size:
USC Campus
XXL
XL
L
M
Detach and send a check made out to ALL NET BASKETBALL USC Men’s Basketball Attention: Chris Capko 3400 S. Figueroa St Los Angeles, CA Questions: Call Chris Capko (213) 379-2296
Contact Us Call: 213-379-2296 Email: [email protected]
