Camp Policy and Medical Release Form

CAMP POLICY & MEDICAL RELEASE FORM

All participants, parents and/or guardians must read this form, fill in the information, sign it and send it in to complete the registration process

You can fax it to: 954-989-4406, email it to j_mchugh@floridasonsvolleyball.com or you can send it in to:

Florida Sons/Suns Volleyball Club, 2492 SW 57^th Avenue, West Park, FL 33023

PAYMENT

The payment of $30, per session, or $60, for both sessions, which is non-refundable, must be received by December 20, with your registration form and signed camp policy and medical release form. Sign ups after 12/20/2009 and on the day of camp, space permitting, will be $50.00 per session, or $80.00 for both sessions. Credit Cards payments are only accepted on-line at www.floridasonsvolleyball.com. Credit card payments are not accepted @ check-in. Registration form, camp policy and medical release form along with full payment must be received in order to be processed.

CANCELATIONS & REFUNDS

If you must cancel and we can fill your child’s spot, a 50% refund will be given.

PAYMENTS

Make all checks payable to: Florida Sons/Suns Volleyball.Send payments to:

Florida Sons/Suns Volleyball,

2492 SW 57^th Avenue,

West Park, FL 33023

Credit Cards payments are only accepted on-line at floridasonsvolleyball.com.

Credit card payments are not accepted @ check-in.

For more information call (954) 260-7444 or e-mail j_mchugh@floridasonsvolleyball.com

SUPERVISION & CONDUCT

All participants are expected to conduct themselves responsibly and follow all rules. Participants are expected to be on time. Supervision will be provided for ALL participants.

MEDICAL RELEASE APPROVAL

Name of Camper_________________________________

Male/Female (circle one)

Past Health ______________________________________

Past Injuries _______________________________________________

Present Medication __________________________________________

Allergies _______________________________________

Insurance Company ___________________________

Policy # ______________________

Policy Holder _________________

Insurance Company Address _________________________________________________________________________________

I verify that my child has been checked by a licensed physician and is physically able to participate in the Florida Sons/Suns Volleyball 1st Annual Holiday Volley-Palooza. I hereby agree and promise that I will not hold Florida Sons/Suns Volleyball nor its coaches or athlete assistants responsible for any loss, damages, or personal injury received as a result of participation. I hereby authorize the Club Director of the Florida Sons/Suns Volleyball to act for my child according to their best judgment in an emergency requiring medical attention. I agree to allow my child to be treated by a certified athletic trainer or licensed physician (if necessary) and to assume costs related to such treatment. I authorize my insurance company to pay benefits to the treating hospital. Also, I authorize the disclosure of medical information to my insurance for the purpose of claim. This camp is not an official function of Sagemont School, Weston.

Parent or Guardian Signature ________________________________

Print Name __________________________

Date _______________

Street Address _________________________________________________________________________

City _________________________________ State _________ Zip ____________

Home ( ) __________________ Cell ( ) __________________