RELEASE AND WAIVER OF LIABILITY
Fort Valley State University Fitness Center
I hereby acknowledge that participation in the
Natalie White 3rd Annual Girls & Boys
Basketball Camp is an inherently dangerous activity. I
understand that risks include serious injury or death,
from such hazards as weather conditions, falls, aerobic
exercises, isotonic activities, cardiovascular activities,
contact with other participants, and other potential
hazards. I acknowledge that I should not enter or
participate in this event unless I am medically able and
properly trained.
For the sole consideration of allowing me to participate
in this event, I hereby release and forever discharge
Natalie White and camp volunteer staff, Fort Valley
State University, the Board of Regents of the University
System of Georgia, their members individually and their
officers, agents and employees from any and all claims,
demands, rights and causes of action arising from any
personal injury, property damage, or the consequences
thereof, resulting from or in any way connected with my
participation in this activity.
I understand that the acceptance of this Release, Waiver
of Liability and Covenant Not to Sue by the Board of
Regents of the University System of Georgia, Natalie
White and camp volunteer staff shall not constitute a
waiver, in whole or in part, of sovereign immunity by
said Board, its members, officers, agents, and employees.
I certify that I am at least 18 years of age and that I have read and understood the above.
___________________________________________________________
Signature of Parent/Guardian Date
Printed Name:
_____________________________________________________________
Address:
_____________________________________________________________
City, State and Zip:
_____________________________________________________________
E-Mail Address:
_____________________________________________________________
Emergency Contact Number:
_____________________________________________________________
Please detached application and mail back
Natalie White
Natalie White
3rd Annual Girls & Boys Basketball Camp
GIRLS & BOYS AGE: 6-17
Tuesday, May 31 - Thursday, June 2, 2011
$90.00 Camp Fee
9:00AM-4:00PM
Send application, Waiver and $90 Camp Fee
to:
Natalie White
110 Gawin Drive
Warner Robins, GA 31093
Cell: 478-714-4624
Email: [email protected]
CAMP LOCATION:
FORT VALLEY STATE UNIVERSITY
HEALTH & PHYSICAL EDUCATION COMPLEX
1005 STATE UNIVERSITY DRIVE
www.fvsu.edu
Natalie White
3rd Annual Girls & Boys Basketball Camp
GIRLS & BOYS AGE: 6-17
Tuesday, May 31 - Thursday, June 2, 2011
Natalie White 2nd Annual Girls and Boys
Basketball Camp 2010
NATALIE WHITE
3rd ANNUAL BASKETBALL CAMP
May 31 - June 2, 2011
Name_______________________________________
Address_____________________________________
City_________________________________________
Home Phone____________Cell Phone____________
EMAIL_____________________________________
Parent/Guardian______________________________
Birthdate___________________________
Age____________ Male or Female
Youth Shirt Size (circle one) S M L XL
Adult Shirt Size (circle one) S M L XL
Money Order: $______________
Check: $__________ Cash: $__________________
Refund/Cancellation Policy: Your fee will be
refunded without question if you cancel your
enrollment provided the request is made more than
two weeks prior to start of the camp. Within two
weeks of the start of the camp, no refunds will be
made unless for medical reasons and a physician’s
letter must be provided upon request of a refund.
After the start of the camp begins, no refunds will be
made.
(Please call for more details)
Signature:_________________________________
Date: ____________________________________
PLEASE SIGN THE ATTACHED
RELEASE AND WAIVER OF LIABILITY FORM
Please detached application and mail back
This camp is designed to teach the fundamentals
of basketball to beginning level players and to
enhance the skill level of intermediate or
advanced players. Girls and Boys ages 6-17 are
encouraged to participate in this fun and
energetic three day camp. This camp focuses on
the fundamentals of basketball through station
work and competition.
CAMP HIGHLIGHTS
Camp T-Shirt
Camp Certificate
Competition, Trophies and Special Awards
Meals (Breakfast and Lunch provided)
Guest Speakers/Panel Discussion
Experienced Coaches/former collegiate players
Prizes/Raffles Daily
NCAA Compliance & Eligibility
Free WNBA Atlanta Dream Game Ticket
Main Inside Heading
Come Join the Fun !
Main Inside Heading
Camp Highlights and Information
Conditioning
Agility
NatalieWhite and Damien Smith show the correct defense position
Layups
Station Drills
