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  • 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: nwhite10@hotmail.com

    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

    mailto:nwhite10@hotmail.com http://www.fvsu.edu

  • 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