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INDIANA VOLLEYBALL CAMPS


Youth "Parent Date Night" Camp

Grades 5-8

May 3, 10, 17, 31, 2013, Bloomington, Indiana, at Indiana University

University Gymnasium

5:30-8:30 p.m.

CAMP COSTS

$50.00 (Single Day)*
$150.00 (Four Days)*


* add 6% for on-line registrations


All Camps Open to All and Any Entrants


FOR REGISTRATION INFORMATION/INQUIRIES:


- Phone: 1-812-856-0300
- E-Mail: For Further Information!
- Register On-Line: Now Available!
- Summer Camp Discounts

2013 Youth "Parent Date Night" Camp

Registration Note All campers who cancel, including those for medical reasons, will be refunded all pre-paid fees, minus a $15 administrative fee, provided they cancel before May 1, 2013. Cancellations after May 1, 2013, but before the start of camp will be refunded all pre-paid fees minus a $25 administrative fee. No refunds will be issued after the start of camp for any reason.

Please complete the form below and submit camp payment.

 
Payment Option*
 Credit Card
 Mailing in Check*
 
* If you are mailing in a check, completely fill out this form and click on the 'register' button at the bottom of the page. On the next page, you can exit your web browser. Then, you can mail in your check made payable to IU Volleyball Camp to: IU Volleyball Camp; 1001 E. 17th Street; Bloomington, IN 47408. As a reminder, if mailing in a check the camp fee is $150 for all four days or $50 for an individual day. If you are either an IU employee or an IU Athletics employee, please refer to the IU Employee Discounts link on the left for discounted pricing.

In the memo line of your check, please indicate the name or names that payment is for, and which session(s) you have signed up for.
 

INTERNAL USE - Campers DO NOT fill out next two lines  
Check Received (Check #, Date, Amount)
 
Balance Due
 
Which date are you registering your child for?*
 

Camper's Last Name*
 
Camper's First Name*
 
Birthdate (Month/Day/Year)*
 
Parent/Guardian Name(s)*
 
Home Address*
 
City*
 
State*
 
Zip*
 
Camper's Home Phone #*
 
Parent's Cell Phone #
 
Parent's E-Mail Address*
 
Grade Entering (as of Sept. 2013)*
 
Camper's School*
 
T-Shirt Size (adult sizes)*
 S
 M
 L
 XL
 XXL
 

MEDICAL CONSENT FORM
To enable the Health Center of Indiana University and/or other health facilities in Bloomington to provide prompt care to your daughter, we must have a completed Consent Form on file each year. This way, we can help your child without delay in an emergency.
 
Name of Minor*
 
Insurance Company*
 
Policy Number/Group #*
 
Insurance Company Phone
 
Name of policy holder
 
Medical Conditions
 
Present Medication (include dosage)
 
Date of Last Tetanus Toxoid
 
Drug Reactions
 
Any past or present illness or other information that would be useful in the event that treatment is needed
 
Emergency Name and Phone #s to call if parents can't be reached
 
Hay Fever
 Yes
 No
 
Asthma
 Yes
 No
 
Eczema
 Yes
 No
 
Insect Stings
 Yes
 No
 
Other
 

* I grant permission to the Directors, Assistants, or other persons responsible for her care to act on my behalf for said minor in granting permission for evaluation and treatment of medical problems. I understand that should a major medical problem arise, an attempt will be made to notify me by telephone. In the event that I cannot be reached, I hereby give consent to such medical treatment as deemed necessary (including surgery, x-ray examinations and anesthesia to be rendered to said minor by a licensed physician or nurse.)  

* Waiver: I do hereby waive, release and discharge the Indiana Volleyball Camp and the respective staffs, employees, successors, and assigns, of and from any and all rights and claims for damages resulting from injury of my person or property, which may be sustained or suffered by me in connection with my association with or participating in, or arising out of my traveling to or from Indiana Volleyball Camp. We, the parents/guardians, agree to the above waiver and release and we join therein.  

Parent/Guardian Name*
 

PAYMENT OPTIONS
Please select your payment option by indicating a '1' in the quantity field. We need a registration form and consents completed for each participant.

Note: A charge from Hoosiersportscamps.com will appear on your credit card for your on-line registration. However, if the IU Volleyball Camp is cancelled for any reason, refunds must be collected directly from the IU Volleyball Camp, Phone 812-856-3710.
 
Qty 
 $53.00 Option 1 - Single Day Rate - Payment in Full

 $159.00 Option 2 - Four-Day Rate - Payment in Full

 $132.50 Option 3 - Four-Day Rate with IU Discount (Note: Discount available to children of IU employees and valid IU e-mail address required) - Payment in Full

 $80.00 Option 4 - Four-Day Rate with IU Athletics Discount (Note: Discount available to children of IU Athletics employees and valid IU e-mail address required) - Payment in Full