Mail checks payable to: Dr. Ritchie Dulaney
Return completed form and check to Coach Jones
Please circle: T-shirt Size (Adult) S M L XL
Once the application and check is submitted you will receive more detailed camp information
Dr. Ritchie Dulaney Volleyball Camp Application
Camp Dates: June2 – June 6, 2014
Location: Faulkner State Community College
Time: 9:00 am – 5:00 pm
Cost: $175
Individual skills development camp & daily competition
Name: ______Age ______Grade______
Home Address ______City______State______
Zip code ______Phone number ______Email ______
Contact in case of emergency: Name______Phone # ______
To be completed by all campers and their parents. The participant and her parent must sign in the presence of a witness.
Release of Liability
I understand that my camper ______has the opportunity to participate in the Dr. Ritchie Dulaney volleyball camp to be held at Faulkner State Community College.
In consideration of the school permitting my camper the opportunity to participate in this activity, I, in full recognition and appreciation of any risk, hazards or danger inherent in this activity to which my camper may be exposed, do hereby agree to assume all of the risk and responsibility surrounding my camper’s participation in such activity. In addition, I understand that transportation to and from is not the responsibility of the school. Further, I do for myself hold harmless and indemnify, release and further discharge the school against any and all claims, demands, and action or causes on account of or result from my camper’s control or and without the fault of negligence of the school, its trustees, officers, agents or Dr. Ritchie Dulaney during the period of the student’s participation as foresaid.
I fully understand the risks involved in such activity and I agree to assume those risks involved in my camper’s participation in this activity. I understand that the school and its trustees, officers, employees, agents and Dr. Ritchie Dulaney assume and accept no liability for personal property. This is also to certify that my camper is physically fit.
IN WITNESS WHEREOF, I HAVE CAUSED THIS RELEASE TO BE EXECUTED ON ______DAY OF ______.
PARTICIPANT SIGNATURE ______DATE ______
PARENT SIGNATURE ______DATE ______
WITNESS ______DATE ______