Camper Name: ____________________
Age in June'08:
Grade in Fall '08:
Address: ___________________________
City: __________
State: ___ Zip: _____
Home Phone
#: (____ ) _________ Email:
____________
Height:
Position: _______ School:
" HORNET WAY" CAMP
Camp Choice(s):
"Hornet Way" All-Skills Camp
"Hornet Way" Advanced Camp
_______ Resident Camper
_______ Resident Camper
_______ Day Camper _______ Day Camper
* Each camper will receive a ESU customized vollleyball *
SPECIALTY CAMP
Camp Choice(s): Hitters
Setters
* Each camper will receive a ESU customized vollleyball *
Hornet Way camps: $50.00 Deposit Required and balance due at registration
Specialty Camps: Balance may be paid in full
or at door.
Send application, along with payment to:
Jiangping Wang - Volleyball Coach
Emporia State University
1200 Commercial St. Box 4020
Emporia, KS 66801
For more information, please contact:
Camp Director - Jiangping Wang
Volleyball Coach of Emporia State University
Phone: 620-341-5931; Fax: 620-341-5603
Email: jwang@emporia.edu
Insurance
All campers must be covered by their own medical insurance while attending camps. A qualified athletic trainer will be available
at all times for first aid procedures. If taping is needed, please bring
your own tape and pre-wrap.
Participant and Parental/Guardian Permit
As the participant and the parent or legal guardian of _____________________, I hereby
give permission for myself/my daughter to participate in the Emporia State University
Volleyball Camps and acknowledge the fact that I/she is physically able to participate
in camp activities. I have no knowledge of any physical impairment that would
be affected by the camper's participation in the camp. I further acknowledge
that an element of sickness and risk are present that could result in acute injury, chronic conditions, total paralysis, or death in participantion and I hereby waive and release ESU Volleyball Camp and Its Staff from any liability or claims arising from activities. I also grant permission for treatment deemed necessary for a condition arising during participation in the camps. The following
consent forms should be signed by the participant and the parent/guardian so that no unnecessary
delays will occur with first aid/hospital procedures.
Signature:
Date:
Relationship: ____________________________________________
For more informationPlease contact
Jiangping Wang - Camps Director at:
Phone: 620-341-5931; Fax 620-341-5603
Email: jwang@emporia.edu
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