Page 1

BU VOLLEYFEST 2012

Attention all 3rd, 4th, 5th and 6th graders! Come join us for a night of fun and volleyball!

Friday, March 23 6pm to 11pm $50 Entry 6-730pm Instructional camp 730 to 8pm Pizza with the Bruins 8-9:30pm 6x6 Tournament 9:30-10:30pm 2x2 tournament/ serving contest 10:30-11:00pm Bruin Volleyball Video

Trish Siedlik, Head Coach Bellevue University * 1000 Galvin Road * Bellevue, NE 68005* siedlik@bellevue.edu * 402.660.5906


2012 CAMP APPLICATION

PARENTAL CONSENT FORM

(PLEASE PRINT CLEARLY)

(PLEASE PRINT CLEARLY)

Name: ___________________________________

I, the undersigned, as the parent or legal guardian of a minor child, __________ __________ hereby acknowledge that the aforenamed child is covered by medical insurance as follows:

Grade (Fall of 2012): ________ Age: ___________

It is further understood that the Bruin Volleyball Camp does not provide medical insurance for this camp. The undersigned hereby releases Bellevue University and its staff from any and all claims, demands, and causes of action whatsoever in any way growing out of or resulting from participation by the aforenamed child in the Bruin Volleyball Camp.

Address: _________________________________ City/ST/Zip: ______________________________

__________________________________________

Parents: _________________________________ Home Phone: _____________________________

Signature of the parent/Guardian _______________ Date Please provide the following information about the enrolled camper:

Cell Phone: _______________________________

__________________________________________ Allergic Reactions

Size Tshirt: S M L (adult sizes)

__________________________________________ Present Medications

PAYMENT INFORMATION Please mail payment and camp application with parental consent form to:

__________________________________________ Past Injuries, Illnesses or other Information

IN CASE OF EMERGENCY: Contact: __________________________________ Contact Phone: _____________________________

Bellevue University Volleyball Attn: Trish Siedlik 1000 Galvin Road

Insurance Company: _________________________ Policy Holder: ______________________________ Policy Number: _____________________________

/BU_volleyfest2012  

http://bubruins.com/documents/2012/2/1/BU_volleyfest2012.pdf?id=148