Mail Checks Payable To: Dr. Ritchie Dulaney

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 ______