Clarion University 2010 Athletic Camps
Rt. 220 Individual Camps July 11-15 July 18-22 Cost: $290, recommended ages 10-17 To become a good basketball player, each athlete must learn the fundamentals of the game. Through exposure to competitive and keen basketball minds, we hope to instill the burning desire it takes to become a successful player and person. Special attention will be given to each player s present degree of skills and achievement Clarion coaches and their carefully selected staff are present every day during the two weeks of camp activities. We believe in personalized instruction and in providing an atmosphere of good sportsmanship and fair play. Camp Information Fundamental Air-conditioned facility; five indoor basketball courts Instruction from some of the area s top high school and college coaches and players Camp T-shirt for all participants All-you-can-eat meals Large swimming pool, game room, tennis, etc. Clarion Hospital is located within three miles of campus Team Camp July 16-17 Cost: $100 team deposit plus $25 per player Two competitive one-day shoot-outs for JV and varsity teams. Each team is guaranteed four games per shootout. If teams attend both shoot-outs, on-campus lodging and food can be provided at additional cost. Information on affordable local hotels and restaurants will also be provided. Our coaches provide as much game experience and instruction as possible during the week. The emphasis is on having a good time as well as playing the game of basketball. I get great satisfaction personally working with the campers and seeing them improve. - Coach Ron Righter Competitive Directions to Clarion University From Ohio: take I-80 East to Clarion, Exit 64 Eastern PA: take I-80 West to Clarion, Exit 64 Erie area: take I-79 South to I-80 East to Clarion, Exit 64 Pittsburgh area: take I-79 North to I-80 East to Clarion, Exit 64 Erie NEW YORK Contact Information Coach Ron Righter Clarion University of Pennsylvania 840 Wood Street Clarion, PA 16214-1232 814-393-2458 or 393-2510 OHIO Interstate 79 Interstate 80 Franklin Pittsburgh PA Turnpike WEST VIRGINIA Clarion Johnstown PENNSYLVANIA Clarion University Rt. 219 Rt. 36 Rt. 220 Altoona Interstate 80 State College Williamsport Interstate 81 Interstate 81 xt. PA Turnpike Scranton Interstate 80 Allentown Harrisburg Philadelphia PA Turnpike www.clarion.edu PA Turnpike
Boys Basketball Individual Camps CLARION UNIVERSITY OF PENNSYLVANIA 2010 APPLICATION Please enroll me in the Clarion Boys Basketball Camp. It is understood that Clarion University, the directors, or anyone connected with the school will not assume any responsibility for accidents, medical or dental, or any other expenses incurred as a result of accidents. Age Grade as of September 2010 E-mail Home phone of high school Street City State Zip Area Code How did you hear about our camp? Roommate preference Check T-shirt size (adult sizes): Medium Large X-Large Coach Check one: Individual Camp July 11-15 Individual Camp July 18-22 Check one: Resident Commuter There is no deadline for the $80 deposit. However, we recommend you send it in 30 days prior to the start of camp to secure your spot. Payment Type: Check Check No. Money Order PARENT OR GUARDIAN SECTION: I certify my son has no injury or illness that could jeopardize his well-being by participating in the basketball activities of the Clarion University Boys Basketball Camp. Signature Date Please send camp information to my friends: MAIL APPLICATION TO: COSTS: Men s Basketball Office Clarion University of Pennsylvania 840 Wood Street Clarion, PA 16214-1232 Resident Commuter $290 $250 Make checks payable to Clarion University of Pennsylvania $50 non-refundable fee prior to last day of camp.
Boys Basketball Varsity Team Camp CLARION UNIVERSITY OF PENNSYLVANIA 2010 APPLICATION It is understood that Clarion University, the directors, or anyone connected with the school will not assume any responsibility for accidents, medical or dental, or any other expenses incurred as a result of accidents. ONE APPLICATION PER TEAM Contact information (This is the person responsible for sending in the team application and will receive all correspondence from the Clarion staff.) CAMP COACH INFORMATION (This is the adult accompanying the team and will be considered a member of the Clarion staff. If this information is the same as the contact information, disregard this portion of the application.) Street ACT 34 clearance required Street ACT 34 clearance required City State Zip Daytime phone Area Code City State Zip Daytime phone Area Code TEAM ROSTER SCHOOL/TEAM NAME 2010-11 Grade 1. 2. 3. 4. 5. 6. Mail in the deposit ($100) and a team roster to reserve a spot for your team! 7. 8. 9. 10. You must pay for a minimum of eight players. Use a separate application for each team that you register. Mail in the deposit and team roster application to reserve a spot for your team! Check the camp you want to attend and whether it is JV, Varsity, or Junior H.S.: Team Camp July 16 Team Camp July 17 Payment Type: Please send in ONLY ONE check per school. Cost: $100 per team and $50 per player Check Money Order Check No. Make all checks payable to Clarion University of Pennsylvania MAIL APPLICATION TO: Men s Basketball Office, Clarion University of Pennsylvania, 840 Wood Street, Clarion, PA 16214-1232 It is the policy of Clarion University of Pennsylvania that there shall be equal opportunity in all its education programs, services, and benefits, and there shall be no discrimination with regard to a student s or prospective student s race, color, religion, sex, national origin, disability, age, sexual orientation/affection, veteran status or any other factors that are not in accordance with local, state, and federal laws. Direct equal opportunity inquiries to Assistant to the President for Social Equity, 207 Carrier Administration Building, Clarion, PA 16214-1232, 814-393-2109.
Informed Consent Release and Express Assumption Risk I,, Parent or Guardian of ( of Parent or Guardian) ( of Child) desire for my child to participate in Sports Camp at Clarion University on. (Dates) I realize injuries can be a consequence or participation in this activity and no amount of reasonable supervision or use of the facility will prevent injury. I appreciate the character of the risk involved and I voluntarily assume on behalf of my child all risk of possible death, harm or injury. I understand and appreciate that such injury could also include, without limitation, serious or permanent injuries to all bodily organs and functions. I am aware of the risk of participation in this designed activity. I have carefully considered how the possible consequences of injury may impact my child s life, and I choose to accept this risk and allow him/her to participate in the designated activity. In accepting this risk, I expressly and explicitly release, discharge and waive any and all responsibility of Clarion University Foundation, Inc., Clarion University of Pennsylvania, Pennsylvania s State System of Higher Education, the Commonwealth of Pennsylvania and the employees, officials or agents of any and all of the foregoing, pursuant or pertaining or related to, or arising from, in any manner, injuries to my child as a result of his/her participation in this activity. By my signature below, I certify that I completely understand this document. Signature of Parent of Guardian Date Witness Date
Summer Sports Camp Medical Information of Athlete Telephone ( ) Please check camp(s) you plan to attend (M: men, W: women, I: individual, T: team) q Baseball q Basketball: MI q Basketball: MT q Basketball: WI q Basketball: WT q Cross Country q Diving q Football: Kids q Football: H.S. q Football: Youth q Soccer: Day q Soccer: Venango q Soccer: Team q Soccer: Elite q Softball: Pitcher q Softball: Hitter q Swimming q Tennis: Day q Tennis/Swim q Tennis Tourney q Volleyball: I q Volleyball: Def. q Volleyball: Set. q Volleyball: Hit. q Volleyball: T q Wrestling: Fund. q Wrestling: T q Wrestling: Tex 1 q Wrestling: Tex 2 q Wrestling: F/S 1 q Wrestling: F/S 2 q Other Date(s) Attending Camp: From / / to / / From / / to / / COMPLETE ALL SECTIONS Please print 1. Home Social Security No. City State Zip Date of Birth 2. Father/Guardian Mother/Guardian Social Security No. Social Security No. Telephone ( ) Telephone ( ). Employer Employer Telephone ( ) Telephone ( ) Please indicate another person that is likely to know where you can be contacted: Relationship Telephone ( ) If you plan to be away from home the week your son/daughter is in camp, please indicate times and procedure that you may be contacted. FEES FOR MEDICAL TREATMENT INCURRED BY YOUR SON/DAUGHTER WHILE AT CAMP WILL BE THE RESPONSIBLE OF THE PARENT/GUARDIAN. AN INSURANCE POLICY WILL NOT BE INCLUDED IN THE CAMP FEES. IF YOUR SON/ DAUGHTER SHOULD REQUIRE MEDICAL TREATMENT WHILE AT CAMP, AND YOU WISH THE COST FOR TREATMENT TO BE COVERED UNDER YOUR MEDICAL INSURANCE PLAN, PLEASE PROVIDE THE FOLLOWING INFORMATION. 3. Basic Medical Major Medical Company or Plan Company or Plan Telephone ( ) Telephone ( ) Policy Number Group Number Policy Number Group Number Please complete the information on reverse side of this form
Is the athlete on any medication of any kind? q Yes q No If YES, please list medication(s), reason for taking, and any special instructions Drug Allergies or Sensitivities Other Allergies Does the athlete require special medical needs? q Yes q No If YES, please explain: Please read BOTH statements below and sign the ONE of your choice! DO NOT SIGN MORE THAN ONE! Both parents/guardian should sign one of the following sections. If one of the parents is unavailable, the signature of the available parent is sufficient. However, if the parents are divorced, only the parent having custody of the athlete should sign. If the athlete has a legal guardian(s), the guardian(s) should sign. 1. If my son/daughter needs medical attention while at summer sports camp at Clarion University, it is my wish that I be contacted before any medical procedures are performed, unless immediate emergency treatment is necessary to save my son/daughter s life, or to prevent permanent debilitating injury. Parent(s)/Guardian(s) Date / / 2. If my son/daughter needs medical attention while at summer sports camp at Clarion University, it is my wish that the treatment be begun while efforts are being made to contact me. So that treatment will not be delayed, I consent to any medical procedures that the attending physician believes to be appropriate, with the understanding that efforts will continue to be made to contact me. I also accept responsibility for all costs related to such treatment. *Exceptions. If there are any medical procedures that you do not want performed until you are contacted, please list them in the space provided. Otherwise, write none. Parent(s)/Guardian(s) Date / / If the athlete is 18 years of age, he/she must also sign this agreement Date / / 2/10