SRJC Summer Snapshot 2016 - Aftershock Volleyball Club

srjc volleyball
Summer SNAPSHOT
2016
Outdoor Volleyball Camp
June 13th-16th
Outdoor Volleyball Class
June 20th-July 27th
Register for Athletics 3 Section 8397
M/W 4:00 - 7:00PM
Indoor Volleyball Camp
July 25th-28th
Grass Volleyball Tournaments
July 16th-17th
&
August 13th-14th
srjc Outdoor
volleyball camp
JuNe 13th-16th
2016
Time: 8:30am-12:00pm
Bailey Field (Football Field/Track)
sANTA rOSA jUNIOR cOLLeGE
Camp Features:
What to Bring:
Camp Tank
Skills and Drill Work
Doubles Strategy
Team Play
Sport Related Conditioning
Prizes
Active Shoes
Active Attire
Water
Sunscreen
Hat/Visor
Registration:
Camp Tuition:
Cash or Check accepted
Make Checks payable to:
SRJC Women’s Volleyball
Registration indicates Confirmation
(cancellation prior to June 1st = full refund)
Walk-ups accepted, there is always room!
$75.00 for week
$125.00 (for two)

Participant Name
DOB
School
Volleyball Experience (none needed, informational only)
Adult T-Shirt Size (check one)
Small
Parent/Guardian Name
Date
Medium
Large
Parent/Guardian Signature
Phone Number
e-mail address
Street Address
City
Medical Insurance Co.
Policy #
X-Large
Zip
Address
Emergency Contact/Pick-up designee & phone #
A medical history and permission form must be completed prior to participation in this camp; fill out prior to attendance or on day of camp.
Please print the required information on this form. Detach the form and mail with check to (bring first day if cash or not enough time to mail):
SRJC Women’s Volleyball -1501 Mendocino Avenue- Santa Rosa, CA 95401
srjc volleyball camp
July 25th-28th
2016
Time: 9:00am-3:00pm
Half day option: 9:00am -12:00pm
Ages: 8 - 18 (seniors)
Haehl Pavilion (Main Gym)
sANTA rOSA jUNIOR cOLLeGE
Camp Features:
What to Bring:
Camp T-shirt
Skills and Drill Work
Position Work
Team Play
Sport Related Conditioning
Prizes
Active/Gym Shoes
Active Attire
Water
Lunch
Registration:
Cash or Check accepted
Make Checks payable to:
SRJC Women’s Volleyball
Registration indicates Confirmation
(cancellation prior to July 4th = full refund)
Walk-ups accepted, there is always room!
Camp Tuition:
$100.00 for half day
$150 for full day
$275 (for two)

Participant Name
DOB
School
Volleyball Experience (none needed, informational only)
Adult T-Shirt Size (check one)
Small
Parent/Guardian Name
Date
Medium
Large
Parent/Guardian Signature
Phone Number
e-mail address
Street Address
City
Medical Insurance Co.
Policy #
X-Large
Zip
Address
Emergency Contact/Pick-up designee & phone #
A medical history and permission form must be completed prior to participation in this camp; fill out prior to attendance or on day of camp.
Please print the required information on this form. Detach the form and mail with check to (bring first day if cash or not enough time to mail):
SRJC Women’s Volleyball -1501 Mendocino Avenue- Santa Rosa, CA 95401
Santa Rosa Junior College
Activity Notice and
Medical Authorization-Adult
Participant Name: __________________
Activity: _________________________
Date & Time:________________________
As stated in California Code of Regulation, Subchapter 5, Section 55450, I understand that I hold
Sonoma County Junior College District, its officers, agents and employees harmless from any
and all liability or claims arising out of or in connection with my participation in this activity.
In the event of any illness or injury, I hereby consent to any x-ray, examination, anesthetic,
medical, surgical or dental diagnosis or treatment and hospital care from a licensed physician
and/or surgeon as deemed necessary for my safety and welfare. It is understood that the
resulting expenses will be the responsibility of the participant.
Signature: ____________________
Date: ___________________
Address: ______________________ Phone: __________________
______________________________________________________________________________
Medical Insurance Carrier
Policy No.
Address
In the event of illness or accident, please notify:
______________________________________________________________________________
Name
Address
Phone
If there are any special medical problems, kindly attach a description of the problem to this
sheet. Thank you.
PE:/Quinn Share/Medical Authorization-Adult
Revised 7/7/2004