FOOTHILL VOLLEYBALL CAMP 

FOR GIRLS AND BOYS ENTERING GRADES 5 – 8 in Sept. 2010

DATES:  June 28 – July 1 (@ La Canada High School)

                                 TIMES:  Session 1: 8:30 – 12:00 at LCHS (north gym)

               Session 2: 1:30 – 5:00 at LCHS (north gym)

COST:  $160 before June 18, $180 after June 18

 Both sessions:  $260 before June 18, $280 after June 18

             *[siblings pay $15 less per session]

Bring/wear to camp:                                                

t-shirt, shorts                                                athletic shoes and socks                                                 

knee pads (optional)                                      healthy snack AND water                                                   

                                                                                                                                      Questions?        Call  (818)  790-2819             

Make checks payable to: "Foothill Volleyball Camp"  

_________________________________________________________________________

PLEASE FILL OUT THE FORM BELOW AND SEND IT WITH YOUR PAYMENT

__________  _______  __________  _________CUT HERE__________  _________  _________  _______  ______ 

PLEASE PRINT

Camper's Name ___________________________________________      email_____________________________

Address ________________________________________________City __________________Zip______________

School _______________________________  grade next fall _______________   (male/female) ______________

Parent(s) name ______________________________phone: home_)__________________ cell ________________

Emergency contact ______________________________  phone no. __________________________________

T-shirt size    100% cotton      S M L XL (adult)       S M L XL (youth)

SESSION      1        2     

Consent and Release Authorization and Emergency Treatment Form

I hereby give my full consent and approval for my child to participate in the Foothill Volleyball Camp.  I am the parent or legal guardian of the child named on the registration form.  I am willing to assume the risks of injury in practice and play at this camp on behalf of my child.  My child is fully capable of participating in this camp, and I know of no physical or mental disabilities that would limit full participation in camp activities except as listed below.  I hereby waive and release the Foothill Volleyball Camp organization, its staff, coaches, sponsors and representatives of any injury or illness incurred while at camp.   In the event I cannot be reached by phone I authorize the camp staff to obtain medical treatment for my child and will accept full financial responsibility.

Physical limitations (allergies, diabetes, etc.) _________________________________________________________

Parent/Guardian  (signature) _____________________________________________Date ____________________

Medical insurance carrier ___________________________ policy no. __________________________