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CENTRAL WASHINGTON UNIVERSITY Athletics 400 East University Way Ellensburg WA 98926-7570 2011 WILDCAT HIGH SCHOOL VOLLEYBALL TOURNAMENT CAMP TOURNAMENT INFORMATION ENTRY FEE • Three Divisions — Power (high-level varsity) / Intermediate $265. Non-refundable, $100 deposit due by May 27. (lower-level varsity, high JV) / Challenge (JV, “C” team) Balance and T-shirt money due by June 3, 2011. • Pool play followed by elimination tournament for all teams. Entries will be accepted on a ﬁrst-come, ﬁrst-served basis. • Play starts at 9 a.m. on the ﬁrst day and 8 a.m. on the second day Play starts at 9 a.m. on the ﬁrst day and 8 a.m. on the second day. • Up ofﬁcials provided—each team provides individuals for down Pools and team schedules will be e-mailed to coaches a week prior ofﬁcials/score ﬂipper/ linesmen to the tournament • Individual awards for members of championship team in each division (maximum 10 players/ coach) FOR MORE INFORMATION, CONTACT Chloe Quirk, Assistant Volleyball Tournament Director • NEW Individual Skills Clinic Offered before each tournament 400 East University Way, Ellensburg, WA 98926-7570 on June 16-17, and June 19, 2011 (see Skills Clinic Registration) Ofﬁce: 509-963-1907 E-mail: firstname.lastname@example.org CWU is an AA/EEO/Title IX Institution. Persons with disabilities may request reasonable accommodation by calling the Center for Disability Services at 509-963-2171 or e-mailing CDSrecept@cwu.edu. WILDCAT HIGH SCHOOL VOLLEYBALL TOURNAMENT CAMP APPLICATION FORM CAMP DATES: School Name ____________________________________________ Each participant is required to bring a CWU HEALTH/ (Please type or print) EMERGENCY INFORMATION FORM to the tournament. Coach’s Name ___________________________________________ Forms are available online at: www.wildcatsports.com. All Central Washington University (CWU) campers are required Coach’s Mailing Address ___________________________________ to provide a non-returnable physical ﬁtness statement from City __________________________ State ______ Zip ___________ their physician, a medical release, and proof of their own medical insurance prior to their participation in the CWU Camp. Ofﬁce Phone Number (_________) __________________________ (Please include area code) CAMPERS WILL NOT BE ALLOWED TO PARTICIPATE Home Phone Number (_________) __________________________ WITHOUT THESE FORMS. (Please include area code) E-mail __________________________________________________ The CWU athletic training staff will be on duty during the camp TOURNAMENT: sessions and on call throughout the day. Saturday, June 18 - Sunday, June 19 (up to 35 teams) Monday, June 20 - Tuesday, June 21 (up to 20 teams) DIVISION (see tournament information for description): Ofﬁcial Tournament T-shirts can be pre-ordered for a reduced Power (Upper) Intermediate Challenge (Lower) rate at $15 each. Please mark the number and sizes you will need and send the total amount with your balance. Tournament shirts TENTATIVE ROSTER: will be sold at the tournament. 1. ______________________________________________________ __________________________________________________________ 2. ______________________________________________________ Sizes No. of shirts Total amount due ($15 each) 3. ______________________________________________________ __________________________________________________________ S 4. ______________________________________________________ __________________________________________________________ 5. ______________________________________________________ M __________________________________________________________ 6. ______________________________________________________ L 7. ______________________________________________________ __________________________________________________________ 8. ______________________________________________________ XL __________________________________________________________ 9. ______________________________________________________ 10. ______________________________________________________ Make entry/T-shirt fee checks payable to: Central Washington University Athletics Deposit $________________ Return forms and deposit to: Coach’s Signature _________________________________________ Mario Andaya, CWU Volleyball Tournament Director, 400 East University Way, Ellensburg WA 98926-7570. Date ____________________ GENERAL INFORMATION AND FEES CENTRAL WASHINGTON UNIVERSITY CENTRAL WASHINGTON UNIVERSITY Elite Prospect Clinic is $125 (includes lodging, three meals, and T-shirt) Complete Skills Clinic is $50 (includes a T-shirt) Middle School Clinic is $40 (includes a T-shirt) DESCRIPTION Athletics Elite Prospect Clinic — Learn training techniques and NCAA 400 East University Way recruiting rules that will help you prepare for the college level. Ellensburg WA 98926-7570 Evaluations will be given after the clinic. Complete Skill Clinic — Fundamental and volleyball ﬁtness training will be taught with various drills and games. Individual and team strategies will be taught in team competition. Middle School Clinic — For ages 5th through 8th grade. Learn fundamental skills and fun games to improve overall skill. PHYSICAL AND INSURANCE All CWU clinic participants are required to provide a nonreturnable physical ﬁtness statement from their physician, a CWU Camper Health/Emergency Information Form, and proof of their own medical insurance prior to their participation in the CWU Clinic. Individuals will NOT be allowed to participate without properly completed forms. The CWU athletic training 2011 WILDCAT staff will be on duty during sessions and on-call throughout the day. TIMES HIGH SCHOOL Elite Prospect Clinic, June 16 — Check-in 2:30 p.m., Session I 3:00 p.m., Dinner 5:00 p.m, Session II 6:00 p.m. June 17 — Breakfast 8:00 a.m., Session III 9:00 a.m., VOLLEYBALL Lunch at noon, Recruiting Session 1:00 p.m., Session IV 3:00 p.m., Final Session 6:00 p.m., concluding at 8:00 p.m. Complete Skill and Middle School Clinic—Check in at 2:30 p.m. INDIVIDUAL Each clinic will run from 3:00 p.m. to 9:00 p.m. with an hour dinner break at 5:00 p.m. SKILLS CLINIC WHAT TO BRING T-shirt, shorts, athletic court shoes, knee pads, towel, water bottle, and meal or snack for dinner. Please do not bring valuables to camp. FOR MORE INFORMATION, CONTACT Chloe Quirk, Assistant Volleyball Tournament Director 400 East University Way, Ellensburg, WA 98926-7570 Ofﬁce: 509-963-1907 E-mail: email@example.com WILDCAT HIGH SCHOOL VOLLEYBALL INDIVIDUAL SKILLS CLINIC REGISTRATION FORM CLINIC DATES: Clinic attending: June 16-17, 2011 (Elite Prospect) Name ____________________________________________________ June 17, 2011 (Complete Skill) (Please type or print) June 19, 2011 (Complete Skill) Daytime Telephone (________) ______________________________ (Please include area code) June 21, 2011 (Middle School) E-mail Address ____________________________________________ Make check payable to: Central Washington University Athletics Mailing Address ___________________________________________ Return registration form, CWU Camper Health/ City _____________________________________________________ Emergency Information form, and fee to: Mario Andaya, CWU Volleyball Tournament Director, State ________________________________ Zip _________________ 400 East University Way, Ellensburg WA 98926-7570. CWU HEALTH/EMERGENCY INFORMATION FORM FOR CWU SPORT CAMPS WILDCAT HIGH SCHOOL VOLLEYBALL TOURNAMENT CAMP AND SKILLS CLINIC Check dates that apply: June 18-19—Tournament Camp I June 20-21—Tournament Camp II June 16-17—Elite Prospect Clinic June 17—Complete Skill Clinic June 19—Complete Skill Clinic June 21—Middle School Clinic THIS FORM AND A VALID PHYSICAL FITNESS STATEMENT MUST BE PROPERLY SIGNED AND RETURNED BEFORE THE FIRST DAY OF CAMP. Students will not be allowed to participate without properly completed and signed forms. Participant’s Name ___________________________________________________ I, the undersigned, individually and as a parent/guardian of (Please print) ________________________________________________________ (participant), Address ____________________________________________________________ a minor, ask that he/she be admitted to participate in the sports camp sponsored by Central Washington University. City _________________________________ State _______ Zip _____________ I am fully aware of the safety risks of participating in this activity. Birth Date ____________________ Phone (______) _______________________ I acknowledge and accept the risks and I understand that CWU cannot (Month/Day/Year) (Area Code) guarantee my child’s safety. I state to you that I am not aware of any Camp Dates ________________________________________________________ physical condition that would limit my child’s participation in this activity. I understand that it is my responsibility to let you know if my child has any condition that would limit his/her ability to safely participate in this activity. DOES YOUR CHILD HAVE: In exchange for my child being allowed to participate in this activity, and to the fullest extent permitted by law, I hereby waive and release—and further Allergies Yes No If yes, list. ______________________________________ agree to indemnify, defend, and hold harmless Central Washington University and its trustees, ofﬁcers, agents, employees, and volunteers from and against— ____________________________________________________________________ any and all liabilities, claims, costs, expenses, injuries, and or/losses that I or my minor child may sustain as a result of my child’s attendance at the sport Chronic illness, such as heart condition, asthma, epilepsy, diabetes, etc. camp, or in the course of competition and/or activities held in connection with the sport camp. Yes No If yes, list._______________________________________________ I hereby give consent for medical treatment and agree to assume all ____________________________________________________________________ responsibility for payment of medical bills and expenses. Furthermore, I will be responsible for ﬁling all claims with all insurance companies. You Has your child had any injuries and/or operations during the past year? have my permission to release a copy of this form and the personal insurance information below to any medical provider treating my child. Yes No If yes, list type and dates. _________________________________ I also give permission for my child’s photograph to appear in promotional ____________________________________________________________________ material regarding future camps. Signature of Has your child’s physical activity been restricted during the past year? Parent/Guardian___________________________________ Date _____________ Yes No If yes, list reasons and duration. ____________________________ ____________________________________________________________________ (Please print name and relationship to participant) ____________________________________________________________________ IN CASE OF EMERGENCY, NOTIFY: Is your child taking any medications? Yes No If yes, why?_____________ Name ______________________________________________________________ ____________________________________________________________________ (Please print) Name of medication(s) and dosage(s). __________________________________ Relationship ________________________________________________________ ____________________________________________________________________ Address ____________________________________________________________ City _________________________________ State _______ Zip _____________ Has your child ever taken any sulfa drugs? Yes No Phone: Work (______) _________________ Home (______) __________________ (Area Code) (Area Code) Has your child had adverse reactions to any drugs? Yes No Family Physician ___________________________ Phone (______) ____________ (Area Code) If yes, list drug(s) and reaction(s): ______________________________________ Medical Insurance ___________________________________________________ ____________________________________________________________________ Name of Insured ____________________________________________________ Date of last tetanus immunization: _____________________________________ Policy/Group # _____________________________________________________ Coaches: Please make copies for each participant.
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