Clone of Spring Clinic Registration Form

WHAT:

Spring Volleyball Camps for girls entering 3^rd through 12^th grade!

WHEN:

3^rd-4^th Grade Camp: Monday, July 20th - Thursday, July 23rd; 11:00am-1:00pm

5^th-8^th Grade Camp: Monday, July 20th - Thursday, July 23rd; 11:00am-1:00pm

9^th-12^th Grade Camp: Monday, July 20th - Thursday, July 23rd; 8:30am-11:00am

WHERE:

Camps will be held at the Champlin Park High School Fieldhouse

COST:

3^rd-4^th Grade Camp: $80 per player

5^th-8^th Grade Camp: $80 per player

9^th-12^th Grade Camp: $105 per player

All camps will be led by John Yunker, Head Volleyball Coach at Champlin Park High School with the assistance of other Champlin Park High School coaches and players. Players should dress accordingly; tennis shoes, shorts, and a t-shirt (NO TANK TOPS!). Players should also bring a water bottle.

3^rd-4^th Grade Camp: This camp is designed to introduce the sport of volleyball to our future all-stars!! The main focus of the camp will to introduce the FUNdamentals of volleyball through drills and games.

5^th-8^th Grade Camp: This camp is designed to build on the fundamentals that players have gained through previous camps and prepare them for team and league play. Players will continue to build the fundamentals needed to be successful in volleyball as well as learn more advanced skills needed for the next level.

9^th-12^th Grade Camp: This camp is much more advanced as participants are preparing for the high school season! A review of both the fundamentals and advanced skills will take place along with game-like drills where players can use the skills that they have developed along the way.

*Once you complete the online form, please mail a check payable to:

Synergy Sports

7061 Orchid Lane North

Maple Grove, MN 55311

If you have any questions, please email cprebelsvb@gmail.com.

GO REBELS!!

3rd - 8th Grade Clinic ($40/both days)3rd - 8th Grade Clinic ($25/Wednesday)3rd - 8th Grade Clinic ($25/Thursday)

Athlete Information

Athlete's Name

First NameLast Name

Birth Date

MonthDayYear

Age

Grade (Current)

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Parent/Guardian Information

Name

First NameLast Name

Home Number

Area CodePhone Number

Cell Number

Area CodePhone Number

E-mail

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Area CodePhone Number

Alt. Phone Number

Area CodePhone Number

Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the athlete prescribed an inhaler? If yes, please explain any instructions.

Informed Consent and AcknowledgementI hereby give my approval for my child’s participation in any and all activities prepared by Champlin Park/Synergy Sports during the selected camp. In exchange for the acceptance of said child’s candidacy by Champlin Park/Synergy Sports, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Champlin Park/Synergy Sports and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.In case of injury to said child, I hereby waive all claims against Champlin Park/Synergy Sports including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Medical Release and Authorization

As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the {Organization} . and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Champlin Park/Synergy Sports Spring Volleyball Clinic Registration