volleyball camp
Release Agreements Form for HSU Sport Camp (Assumption of Risk/Health Statement/Liability Waiver)
RELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS Activity: ___________________________________________________________________ Activity Date(s) and Time(s): __________________________________________________ __________________________________________________________________________ Activity Location(s): _________________________________________________________ In consideration for being allowed to participate in this Activity, on behalf of myself and my next of kin, heirs and representatives, I release from all liability and promise not to sue the state of California, the Trustees of The California State University, California State University, Humboldt State University, and their employees, officers, directors, volunteers and agents (collectively “University”) from any and all claims, including claims of the University’s negligence, resulting in any physical or psychological injury (including paralysis and death), illness, damages, or economic or emotional loss I may suffer because of my participation in this Activity, including travel to, from and during the Activity.
2017 Humboldt State Girls
VOLLEYBALL CAMP
I am voluntarily participating in this Activity. I am aware of the risks associated with traveling to/from and participating in this Activity, which include but are not limited to physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability (including paralysis), economic or emotional loss, and/or death. I understand that these injuries or outcomes may arise from my own or other’s actions, inaction, or negligence; conditions related to travel; or the condition of the Activity location(s). Nonetheless, I assume all related risks, both known or unknown to me, of my participation in this Activity, including travel to, from and during the Activity. related to travel; or the condition of the Activity location(s). Nonetheless, I assume all related risks, both known or unknown to me, of my participation in this Activity, including travel to, from and during the Activity.
Meals Provided 5 lunches. Check-In All participants must check in to camp headquarters located on the second floor of the Recreation and Wellness center in Lumberjack Arena between 8 a.m. and 9 a.m. on Monday, August 7. The first on-court session will begin at 9 a.m. in Lumberjack Arena. Complete payment and parent waiver form is due at check-in.
I agree to hold the University harmless from any and all claims, including attorney’s fees or damage to my personal property that may occur as a result of my participation in this Activity, including travel to, from and during the Activity. If the University incurs any of these types of expenses, I agree to reimburse the University. If I need medical treatment, I agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance. I am 18 years or older. I understand the legal consequences of signing this document, including (a) releasing the University from all liability, (b) promising not to sue the University, (c) and assuming all risks of participating in this Activity, including travel to, from and during the Activity. I understand that this document is written to be as broad and inclusive as legally permitted by the state of California. I agree that if any portion is held invalid or unenforceable, I will continue to be bound by the remaining terms. I have read this document, and I am signing it freely. No other representations concerning the legal effect of this document have been made to me.
Check-Out Camp will end at 4 p.m. Friday, Aug. 11 following the afternoon on-court session. The last session will be tournament play (1 p.m.). Parents are invited to attend.
Participant Signature: _________________________________________________ Participant Name (print): ______________________________________________ Date: _____________________ If Participant is under 18 years of age: I am the parent or legal guardian of the Participant. I understand the legal consequences of signing this document, including (a) releasing the University from all liability on my and the Participant’s behalf, (b) promising not to sue on my and the Participant’s behalf, (c) and assuming all risks of the Participant’s participation in this Activity, including travel to, from and during the Activity. I allow Participant to participate in this Activity. I understand that I am responsible for the obligations and acts of Participant as described in this document. I agree to be bound by the terms of this document. I have read this liability waiver document, and I am signing it freely. No other representations concerning the legal effect of this document have been made to me. _____________________________________ Signature of Minor Participant’s Parent/Guardian _____________________________________ Name of Minor Participant’s Parent/Guardian
__________________ Date
_____________________________________ Minor Participant’s Name
Camp Features • Individual player evaluation • Serving, passing, setting, spiking skill instruction • Daily competition and game-like drills • Excellent coach-to-camper ratio • Athletic Trainer at every session • Strength & Conditioning session • Humboldt State T-Shirt • Humboldt State drawstring backpack • Camp photo • All you can eat lunch
August 7-11, 2017 Lumberjack Arena Grades 5-12
What to Bring Shorts, t-shirts, kneepads, playing shoes (broken-in rather than new shoes are suggested), socks and personal wear. The climate is cool so be sure to bring some items to keep you warm (sweats, jacket). Some additional money is recommended for snacks. Please do not bring items such as CD players or iPods, or large amounts of cash. HSU is not responsible for lost or stolen items.
Sample Daily Schedule 8:30-9:00 a.m. Drop off 9-11:30 a.m. Morning Session 11:30-1 p.m. Lunch 1-4 p.m. Afternoon Session On-Court Sessions: Focus on individual skills, combination drills that emphasize individual skills, and controlled scrimmage situations. Fees Individual Camper__________________$300 Enrollment Enrollment is limited. An application form is required to secure a spot. Payment in full and parent waiver from are required at the start of camp. Please return application and payment (made payable to HSU Volleyball Camp) to: HSU Student Financial Services, ATTN: Volleyball Camp, 1 Harpst St., Arcata, CA 95521 Contact Information HSU Volleyball Office Phone: 707-826-6017 Athletic Department Phone: 707-826-3666 Fax: 707-826-5446 Email: [email protected]
Kelly Wood Kelly Wood will begin her fifth season as the Lumberjacks’ head coach this fall. In just four seasons of coaching at Humboldt State, Wood has the third-highest winning percentage for a head coach in program history. Wood grew up in Southern Humboldt County, and was a multi-sport star at South Fork High School. She served as head coach at Santa Rosa JC for 10 years, guiding the Bear Cubs to seven appearances in the California Community College State Championships. Her teams appeared in six consecutive CCCSA tournaments and won four Big Eight Conference titles in five years, earning her recognition as Conference Coach of the Year Honors three times and Regional Coach of the Year twice.
___________________________________ Camper Name
_____________________________________________________ Address _____________________________________________________ City, State, Zip _____________________________________________________ Parent Name _____________________________________________________ Phone Parent Cell Phone _____________________________________________________ Name of School _____________________________________________________ Grade in Fall 2016 Age Shirt Size Height
Payment Information Please check appropriate box:
Commuter Camper — $300 NST-ATH JO84
Please check appropriate box for payment method:
Greg Railsback Greg Railsback brings 19 years of volleyball coaching experience to Humboldt State, where he will begin his fifth season as the Lumberjacks’ assistant coach this fall. Most recently, Railsback served as head coach of the Santa Rosa Junior College men’s club, a team he guided to a conference championship and national runner-up finish in 2011. On-Court Coaches Current HSU players will also participate as camp coaches. They’ll be joined by alumni and other local coaches.
0
0Credit Card _______ Amount to be charged
0Check
_______________________________________________________________________ Name on Card _______________________________________________________________________ Credit Card # Expiration Date _______________________________________________________________________ Signature
Mail Registration & Waiver To:
HSU Student Financial Services Attn: HSU Volleyball Camp 1 Harpst St. Arcata, CA 95521
RELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS Activity: ___________________________________________________________________ Activity Date(s) and Time(s): __________________________________________________ __________________________________________________________________________ Activity Location(s): _________________________________________________________ In consideration for being allowed to participate in this Activity, on behalf of myself and my next of kin, heirs and representatives, I release from all liability and promise not to sue the state of California, the Trustees of The California State University, California State University, Humboldt State University, and their employees, officers, directors, volunteers and agents (collectively “University”) from any and all claims, including claims of the University’s negligence, resulting in any physical or psychological injury (including paralysis and death), illness, damages, or economic or emotional loss I may suffer because of my participation in this Activity, including travel to, from and during the Activity.
2017 Humboldt State Girls
VOLLEYBALL CAMP
I am voluntarily participating in this Activity. I am aware of the risks associated with traveling to/from and participating in this Activity, which include but are not limited to physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability (including paralysis), economic or emotional loss, and/or death. I understand that these injuries or outcomes may arise from my own or other’s actions, inaction, or negligence; conditions related to travel; or the condition of the Activity location(s). Nonetheless, I assume all related risks, both known or unknown to me, of my participation in this Activity, including travel to, from and during the Activity. related to travel; or the condition of the Activity location(s). Nonetheless, I assume all related risks, both known or unknown to me, of my participation in this Activity, including travel to, from and during the Activity.
Meals Provided 5 lunches. Check-In All participants must check in to camp headquarters located on the second floor of the Recreation and Wellness center in Lumberjack Arena between 8 a.m. and 9 a.m. on Monday, August 7. The first on-court session will begin at 9 a.m. in Lumberjack Arena. Complete payment and parent waiver form is due at check-in.
I agree to hold the University harmless from any and all claims, including attorney’s fees or damage to my personal property that may occur as a result of my participation in this Activity, including travel to, from and during the Activity. If the University incurs any of these types of expenses, I agree to reimburse the University. If I need medical treatment, I agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance. I am 18 years or older. I understand the legal consequences of signing this document, including (a) releasing the University from all liability, (b) promising not to sue the University, (c) and assuming all risks of participating in this Activity, including travel to, from and during the Activity. I understand that this document is written to be as broad and inclusive as legally permitted by the state of California. I agree that if any portion is held invalid or unenforceable, I will continue to be bound by the remaining terms. I have read this document, and I am signing it freely. No other representations concerning the legal effect of this document have been made to me.
Check-Out Camp will end at 4 p.m. Friday, Aug. 11 following the afternoon on-court session. The last session will be tournament play (1 p.m.). Parents are invited to attend.
Participant Signature: _________________________________________________ Participant Name (print): ______________________________________________ Date: _____________________ If Participant is under 18 years of age: I am the parent or legal guardian of the Participant. I understand the legal consequences of signing this document, including (a) releasing the University from all liability on my and the Participant’s behalf, (b) promising not to sue on my and the Participant’s behalf, (c) and assuming all risks of the Participant’s participation in this Activity, including travel to, from and during the Activity. I allow Participant to participate in this Activity. I understand that I am responsible for the obligations and acts of Participant as described in this document. I agree to be bound by the terms of this document. I have read this liability waiver document, and I am signing it freely. No other representations concerning the legal effect of this document have been made to me. _____________________________________ Signature of Minor Participant’s Parent/Guardian _____________________________________ Name of Minor Participant’s Parent/Guardian
__________________ Date
_____________________________________ Minor Participant’s Name
Camp Features • Individual player evaluation • Serving, passing, setting, spiking skill instruction • Daily competition and game-like drills • Excellent coach-to-camper ratio • Athletic Trainer at every session • Strength & Conditioning session • Humboldt State T-Shirt • Humboldt State drawstring backpack • Camp photo • All you can eat lunch
August 7-11, 2017 Lumberjack Arena Grades 5-12
What to Bring Shorts, t-shirts, kneepads, playing shoes (broken-in rather than new shoes are suggested), socks and personal wear. The climate is cool so be sure to bring some items to keep you warm (sweats, jacket). Some additional money is recommended for snacks. Please do not bring items such as CD players or iPods, or large amounts of cash. HSU is not responsible for lost or stolen items.
Sample Daily Schedule 8:30-9:00 a.m. Drop off 9-11:30 a.m. Morning Session 11:30-1 p.m. Lunch 1-4 p.m. Afternoon Session On-Court Sessions: Focus on individual skills, combination drills that emphasize individual skills, and controlled scrimmage situations. Fees Individual Camper__________________$300 Enrollment Enrollment is limited. An application form is required to secure a spot. Payment in full and parent waiver from are required at the start of camp. Please return application and payment (made payable to HSU Volleyball Camp) to: HSU Student Financial Services, ATTN: Volleyball Camp, 1 Harpst St., Arcata, CA 95521 Contact Information HSU Volleyball Office Phone: 707-826-6017 Athletic Department Phone: 707-826-3666 Fax: 707-826-5446 Email: [email protected]
Kelly Wood Kelly Wood will begin her fifth season as the Lumberjacks’ head coach this fall. In just four seasons of coaching at Humboldt State, Wood has the third-highest winning percentage for a head coach in program history. Wood grew up in Southern Humboldt County, and was a multi-sport star at South Fork High School. She served as head coach at Santa Rosa JC for 10 years, guiding the Bear Cubs to seven appearances in the California Community College State Championships. Her teams appeared in six consecutive CCCSA tournaments and won four Big Eight Conference titles in five years, earning her recognition as Conference Coach of the Year Honors three times and Regional Coach of the Year twice.
___________________________________ Camper Name
_____________________________________________________ Address _____________________________________________________ City, State, Zip _____________________________________________________ Parent Name _____________________________________________________ Phone Parent Cell Phone _____________________________________________________ Name of School _____________________________________________________ Grade in Fall 2016 Age Shirt Size Height
Payment Information Please check appropriate box:
Commuter Camper — $300 NST-ATH JO84
Please check appropriate box for payment method:
Greg Railsback Greg Railsback brings 19 years of volleyball coaching experience to Humboldt State, where he will begin his fifth season as the Lumberjacks’ assistant coach this fall. Most recently, Railsback served as head coach of the Santa Rosa Junior College men’s club, a team he guided to a conference championship and national runner-up finish in 2011. On-Court Coaches Current HSU players will also participate as camp coaches. They’ll be joined by alumni and other local coaches.
0
0Credit Card _______ Amount to be charged
0Check
_______________________________________________________________________ Name on Card _______________________________________________________________________ Credit Card # Expiration Date _______________________________________________________________________ Signature
Mail Registration & Waiver To:
HSU Student Financial Services Attn: HSU Volleyball Camp 1 Harpst St. Arcata, CA 95521
