1. sports
2. volleyball

 …the journey to the next level.
Florida Gulfside Volleyball Academy is proud to
announce the 2015 Volleyball Summer Training
Camps. These camps are designed for BOYS AND
GIRLS ages 7 -18 that are interested in bringing their
volleyball skills to THE NEXT LEVEL.
Our camps will offer specialized training for specific
skills such as hitting, serving, setting, blocking and
defense. Conditioning skills for the development of
strength, speed and agility are also part of the
camp.
We are committed to make this camp a UNIQUE
VOLLEYBALL EXPERIENCE for all participants.
Space is limited. Register early!
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Location: Seacrest Country Day School – Gym o Address: 7100 Davis Blvd. Naples, FL 34104. Schedule: o June Camp: Monday, June 22 -­‐ Friday, June 26 o July Camp: Monday, July 20 -­‐ Friday, July 24 Time: o 7 to 11 Yrs. Old Session: 9:00am -­‐ 12:00pm o 12 to 18 Yrs. Old Session: 1:00pm -­‐ 4:00pm Cost: o $210 ONE Camp: per session/ per player* o $400 BOTH Camps (June & July): one session / per player ** *Seacrest Country Day School Students Fee Per Camp/ Session: $190 ** One Time Payment on or before June 17, 2015. ONLINE REGISTRATION REQUIRED: CLICK HERE: https://go.teamsnap.com/divisions/25008/registration/8470/register/new OR VISIT OUR WEBSITE: www.gulfsidevolleyball.com → Programs → Player Development Program → Summer Training Camps 2015. ***June Camp Registration will close June 17, 2015 / July Camp Registration will close July 15, 2015***
For questions please Email: floridagulfsidevolleyball@yahoo.com …the journey to the next level.
MEDICAL RELEASE / WAIVER FORM
To be completed by parent or guardian. Please print in ink only. All sections of this form must be filled in. This form may be copied
for additional applications. Your payment, in full, must accompany this registration package.
_________________________ _________________ ____ Gender: Male ____ Female ____ Participant -­‐ Last name First Name Middle Initial _____________________________________ __________ ____ _________ Home Address City State Zip Code _________________________ ____ __________________ Birth date (mm/dd/yy) Age Home Phone PRIMARY CONTACT INFORMATION (PARENT OR GUARDIAN) ____________________________ ____________ ______________ ___________________________ Primary Contact -­‐ Last Name First Name Phone Number Email Relationship to Participant: □ Mother □ Father □ other: _________________ SECONDARY CONTACT INFORMATION (PARENT OR GUARDIAN) ____________________________ _____________ ______________ ___________________________ Secondary Contact -­‐ Last Name First Name Phone Number Email HEALTH INSURANCE INFORMATION Primary Insurance Co.: ___________________________ Primary Policy #: _________________________________ Family Physician Name: ___________________________ Physician Phone #: ________________________________ •
Please elaborate in any medical conditions of which we should be aware: (If none, please write NONE) ______________________________________________________________________________________________________________
__________________________________________________________________________________. •
Please list any medications currently being taken: (If none, please write NONE) ______________________________________________________________________________________________________________
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Please list any allergies: (If none, please write NONE) ______________________________________________________________________________________________________________
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In the past 24-­‐month, have you been tested, diagnosed and/or treated for a concussion? □ YES □ NO Participant signature (regardless of age): __________________________________ Date: ______________/ 20___ Participant ______________________________ has my permission to participate in the camps, training, competition, events, activities and/or travel sponsored by Florida Gulfside Volleyball Academy (FGVA), or any of its regional Volleyball Associations. I approve of the leaders who will be in charge of this program/ camp or tournament. I recognize that the leaders are serving to the best of their ability. I certified that the participant has full medical insurance with the company listed above. I understand and agree that this document will keep in the possession of authorized team (FGVA) and that reasonable care will be used to keep this information confidential. I agree to allow the authorized adult team personnel to release this information in the event of a medical emergency to a third party medical provider. I also certify to the best of my knowledge that the participant name hereon is physically fit to engage in volleyball related activities. I further understand Florida Gulfside Volleyball Academy retains the right for publicity and advertising purposes; photographs, videos and written remarks of campers/ players while training at FGVA Programs. If during the course of my daughter’s activities in volleyball, should she become ill or sustain an injury, I h ereby: □ Authorize or □ Do not authorize (Select ONLY one option) you to obtain emergency medical/ dental care. I will assume financial responsibility for the bills incurred through my insurance company. Parent/ Guardian Signature: ____________________________________ Date: __________________/ 20____