IPV 2008 Summer Camp Registration & Waiver Form
Participant Information:
Athletes Name: _________________________ Parent (s) Name:_______________________
Address:
_____________________________City__________________Zip______________
Phone: ________________ Parent Cell or Emergency Contact: _________________________
School: ___________________Grade in fall: _____Preferred Position: _______B-date:_______
T-shirt Size: ____Email: ________________________________________________________
Clinic Information:
Location: Walker Athletics & Sports Performance Complex,
Beginner Level- 7-9pm, Cost- $125.00 *Cost includes T-shirt
Beginner Level Dates: (Fri.) July 11, 18, 25, & Aug. 1, 8
Intermediate Level- 6-8pm, Cost- $250.00 *Cost includes T-shirt
Intermediate Level Dates: (Tues. & Thurs.) July 8, 10, 15, 17, 22, 24, 29, 31 & Aug. 5, 7
Advanced Level- 8-10pm , Cost- $250 *Cost includes T-shirt
Advanced Level
Dates: (Tues. & Thurs.) July 8, 10, 15, 17, 22, 24, 29, 31
*Middle Hitter Only Option Available for Advance Level participants
Clinic Level: Beginner ____ Intermediate ____ Advanced ____ Middle Hitter_____
Waiver:
I grant permission for camp photos (including my daughter) to be posted on the Illinois
Performance Volleyball, Inc. website. (www.ipvbc.com). I grant Illinois Performance Volleyball, Inc.
(IPV) permission to contact me about future clinics, lessons, volleyball conditioning or tryouts.
I hereby grant
permission for my daughter _______________________________, to attend
the 2008 Summer Volleyball Camp run by Illinois Performance Volleyball, Inc. and
Next Level Athletes, Inc (Speed, Inc). My daughter has no medical condition that would interfere with
her participation in the camp. I release the camp instructors, camp facility (Walker Athletics & Sports
Performance Complex, Lisle) and all staff from any liability from injuries which may occur.
Parent Signature: _____________________________________ Date: ______________
If, during the course of my daughter’s/son’s activities in volleyball, she should become ill or sustain an
injury, I do authorize the Illinois Performance Volleyball, Inc. staff to obtain emergency medical/dental
care. I will assume financial responsibility for the bills incurred through my insurance company.
Parent Signature: _____________________________________ Date: ______________
I do not authorize emergency medical/dental care for my daughter/son.
Parent Signature: _____________________________________ Date: ______________