Print Mail-In Registration - UTSA Women`s Basketball Camps

q June 22-23
Lubomyr Lichonczak
Head Coach
Kristen Holt
Associate Head Coach
Name:
Address:
PAID
ADVANCED CAMP
San Antonio, TX
PERMIT NO. 2474
q June 20-21
Non-Profit Organization
U.S. Postage
TEAM CAMP
SUMMER CAMP COACHING STAFF
City: St: Zip:
Home Phone (
)
-
School:
WOMEN’S BASKETBALL
Emily Sherman
Director of Operations
Lubomyr Lichonczak was announced the eighth head women’s
Coach:
Coach Phone (
)
Grade (Since 2013):
Age:
Nicole Dunson
Assistant Coach
Date of Birth:
Email:
T-Shirt Size:
Team Camp:
(Junior High, High School & AAU Teams)
(Two Divisions: Junior High and High School)
*Deposit of $100 must be made in order to reserve a spot
¡ $350 Team
Advanced Camp (7th-12th grade)*
Make checks payable to UTSA Basketball Camps
*Deposit of $100 must be made in order to reserve a spot
¡ $175
¡ $200 (With campus housing)
basketball coach in the program’s history on Aug. 28, 2013. In Lichonczak’s
second year of Conference USA play, the Roadrunners surprised everyone
with a fourth place finish. Highlights from the 2014-15 season included the
programs first ever win over a top 25 team and a first round bye in the
Conference USA Tournament. Lichonczak has over 25 years of college
coaching experience, spent time in the WBNA, and has coached at the
national level. Lichonczak spent 11 years as the head coach at Radford
University where his teams won 6 Big South Conference championships and
has served time as an assistant coach at Texas A&M, Old Dominion, Ohio
State, and Idaho. In the summer of 2009, Luby spent a year as an assistant
coach for the WNBA’s Washington Mystics, as well as an advanced scout
for the San Antonio Silver Stars, Indiana Fever, and the Minnesota Lynx. In
2007, he was also an assistant coach for the Nigerian Women’s National
Team. Lichonczak earned his bachelors of science in social studies and
education from Idaho and his master of arts degree in athletic administration
from Ohio State. Honors include being named Conference Coach of the
Decade during his stint at Radford University.
Kristen Holt is in her third season as the associate head coach of UTSA.
She was most recently the head coach at Colorado State from 2008-2012,
where her Rams teams consistently moved up the Mountain West Conference
(MWC) standings, including a 9-5 record and third-place finish in 2011-12.
Before being promoted to head coach, Holt spent the 2007-08 season as an
assistant coach and recruiting coordinator for the Rams. Holt came to Fort Collins
from Wichita State, where she was an assistant from 2003-07. Holt also served
on Lichonczak’s coaching staff at Radford from 1995-2001 as an assistant
coach, and she began her coaching career at Xavier in 1993-94. Holt entered
the coaching ranks following a distinguished playing career at Ohio, where
she was a four-year letterwinner, two-year captain and part of the 1988 MidAmerican Conference All-Freshman Team. Named Big South Coach of the Year
in 2002. Named Big South Coach of the Year in 2002.
Nicole Dunson enters her third season as an assistant on Lichonczak’s
staff. Prior to UTSA she was the head girl’s varsity basketball coach at
Richard King High School in Corpus Christi. Dunson is a former guard for the
Roadrunners, where she led the team both on the court and in the classroom
from 2002-2006. Dunson was named the 2005-2006 Southland Conference
Women’s basketball Student-Athlete of the year. Selected to Coach Coastal
Bend Coaches Asocation (CBCA All-Star game and District Champions.
Emily Sherman enters her fourth season as the director of operations
WOMEN’S BASKETBALL
*all camps are open to any/all entrants limited only
by age, gender, number, and/or grade level
for UTSA. Sherman served as assistant girls basketball coach at Notre
Dame Academy in Green Bay, Wisconsin from 2007-2009. She received
her bachelor’s degree in media communications and leadership studies from
St. Norbert College, before going on to earn her master’s degree in high
education administration from Texas A&M.
UTSA Women’s Basketball
ATTN: Emily Sherman
One UTSA Circle
San Antonio, Texas 78249
APPLICATION FOR REGISTRATION
BASKETBALL CAMP DATES
June 20-21…Team Camp
June 22-23.....Advanced
Please send application to:
UTSA Women’s Basketball
ATTN: Emily Sherman
One UTSA Circle • San Antonio, Texas 78249
Team Camp
Insurance and Release
This camp is for junior high, high school, and AAU
teams, which affords an excellent opportunity for teams
to play and work together on different situations in a
highly organized atmosphere.
All participants will be covered by a secondary accident
insurance included in the cost of the camp’s tuition.
The non-duplicating insurance policy covers medical
expenses within the range of its limits, except for those
costs covered by any other valid and collectible insurance
policies. No one will be admitted to the camp without a
signed release and a given insurance policy number. A
full time certified trainer will be on staff to assist with any
injuries and will assess if any further assistance outside
of camp will be needed. You will need to bring your own
supplies if you need to be taped for competition.
We are here to assist AAU, high school, and junior high
coaches in all areas of the game to improve their teams.
We expect to have all players involved in a positive,
competitive situation and to develop a commitment to
excellence. Strong efforts will be made to allow each
camper to make friends, have fun, and enjoy a great
weekend of basketball. Team camp will offer two age
divisions: junior high and high school. Each division will
be made up of school teams and AAU teams. We will
do our best to split the divisions evenly based on talent level.
Each team will be allowed to have two coaches for
dorm lodging and supervision. However, this is not
mandatory. We will have UTSA Women’s Basketball
staff members lodging in the dorms. If a team is not
going to have a coach lodge in the dorms as a supervisor
we need to be notified of that so our staff monitors the
athletes. If parents want to arrange sleeping in the same
dorm they need to contact the assigned dorm prior to
camp to plan accordingly.
Advanced
Equipment and Clothing
Overnight campers are responsible for their own bedding
(twin bed), towels for swimming and showering and
necessary toiletries. All campers are responsible for their
own basketball shoes, t-shirts, shorts, socks, swimsuit and
spending money.
2008 SLC Tournament Champs
UTSA Women’s Basketball staff members will be lodging
in the dorms to supervise the athletes. If parents want to
arrange sleeping in the same dorm they need to contact
the assigned dorm prior to camp to plan accordingly.
Camp participants will be supervised during all
organized time and in the dormitory. Campers will
be required to attend all assigned activities and
instruction sessions and to comply with the rules and
regulations of the governing conduct of all students on
campus. Any violations or abuse of these rules and
regulations will cause immediate dismissal from the
camp without a refund. We will use every precaution
to prevent accidents. We do not, however, assume any
responsibility for medical, dental, and other expenses
incurred as a result of accidents. Parents and guardians
must sign this application before a camper will be
accepted into the camp.
Tuition
June 22-23, 2015
Grades 7th-12th
Per Player:$175*covers tuition, insurance, t shirt, and 2 meals
W/ Housing:$200*covers tuition, housing, insurance, t shirt, and 3 meals
($25 discount to campers that attended the team camp)
2008 NCAA Tournament
2009 NCAA Tournament
Name of Camper:
TEAM CAMP
Address (City, State, Zip):
Home Phone:
Work Phone:
University of Texas at San Antonio
June 20-21, 2015
San Antonio, Texas
Junior High-High School
Cell Phone:
Additional Emergency Contact:
Phone:
Tuition
Per team:$350
Deposit (non-refundable):$100
Please fill out and return the team application form. A medical
release form is required from each camper, and a deposit is
required in order to hold a spot.
I, the undersigned, as the parent or legal guardian of _______________________________
(a minor) hereby authorize such diagnostic, medical and/or surgical treatment of such
minor as may be considered necessary or appropriate under the circumstances for the
treatment of any illness or injury of the minor. The attending physician, appropriate staff,
and the University of Texas at San Antonio and its officers, regents, and employees shall
not be responsible in any way for any consequences from said diagnostic, medical and/
or surgical treatment and are hereby released from any and all claims and causes of action
that may arise, grow out of, or be incident to such diagnosis, treatment, or surgery insofar
as the law allows and provided that these services are performed with ordinary care and
to the best of their ability.
____________________________________
Signature of Parent / Guardian
_____ /_____ /_____
Date
PERTINENT MEDICAL/INSURANCE INFORMATION
(to be completed by parent/guardian):
Allergies:
Current Medical Conditions:
Registration begins at 7:00 am on Saturday, June 20 . Check
out will be immediately following the athlete’s last game.
Current Medication:
Location and Facilities
Insurance Company:
The team camp will have two divisions: Junior High & High
School. Teams will play 5 games minimum with officials on
each court. First day will be pool play, second day will finish
pool play and a single elimination tournament will follow.
Teams are responsible for their own meals.
The housing options are:
utsawomensbasketballcamp.com
Date of Birth:
Parent / Guardian: Housing and Food
APPLY ONLINE AT
NOTE: No Camper will be permitted to participate without a parental signa-ture
waiver and medical release form. UTSA Basketball Camp accept cash, money orders,
cashier’s checks, and personal checks (payable to UTSA Basketball Camp).
Registration will begin at 8:00 a.m. on Monday, June 22nd in
the UTSA Convocation Center. Day 1 will begin at 9am and
end at 9pm. Day 2 will begin at 9am and end at noon.
th
2009 SLC Tournament Champs
University of Texas at San Antonio
Athletic Department
Attn: Women’s Basketball
One UTSA Circle · San Antonio, Texas 78249
Phone: (210)458-4173
UTSA SPORT CAMP MEDICAL RELEASE & PARENTAL
WAIVER CONSENT FOR THE TREATMENT OF A MINOR:
Arrivals and Departures
2009 SLC Champs
The medical release, application, and parental waiver should
be completed, detached, and returned with the full tuition as
soon as possible to the following address
Arrivals and Departures
(10% discount for bringing 3 or more teams)
This camp is designed for high school and very advanced
junior high players only. It will be intense and structured
similar to UTSA Women’s Basketball practices.
Supervision and Rules
University of Texas at San Antonio
Camp Parking
Parking permits will be $5. Please park in the areas that
are marked for permissible use. We are not responsible
for parking tickets.
HOW TO APPLY:
ADVANCED CAMP
For on-campus housing, please contact Emily Sherman at
210.458.4189. The cost is $25.00 per person per day.
Bring your own linens.
Please email rooming list to [email protected].
Other pertinent medical information:
Policy No.:
Phone No. for verification:
Parental/Guardian Waiver
I am the Parent/Guardian of the above named participant who is under the eighteen years of age and
am fully competent to sign this agreement. I acknowledge that my child is in good physical health. In
consideration of participant being permitted to participate in the UTSA sport camp, I hereby accept all
risk to participant’s health and of his/her injury or death that may result from such participation and I
hereby release the above named institution, its governing board, officers, employees and representatives
from any and all liability to participant. Participant’s personal representatives, estate, heirs, next of kin,
and assigns for any and all claims and causes of action for loss of or damage to participant’s property
and for any and all illness or injury to participant’s person including his/her death, that may result from
or occur during participant’s participation in the activity, whether caused by negligence of the institution
,its governing board, officers, employees, or representatives, or otherwise. I further agree to indemnify
and hold harmless the institution and its governing board, officers, employees, and representatives
from liability for the injury or death of any person(s) and damage to property that may result from
participant’s negligent or intentional act or omission while participating in the described activity.
I HAVE CAREFULLY READ THIS AGREEMENT AND UNDERSTAND IT TO BE A RELEASE OF ALL CLAIMS
AND CAUSES OF ACTION FOR PARTICIPANT ‘S PROPERTY THAT OCCURS WHILE PARTICIPATING IN
THE DESCRIBED ACTIVITY AND IT OBLIGATES ME TO IDENTIFY THE PARTIES NAMED FOR ANY LIABILITY
FOR INJURY OR DEATH OF ANY PERSON AND DAMAGE TO PROPERTY CAUSED BY PARTICIPANT’S
NEGLIGENT OR INTENTIONAL ACT OR OMISSION.
Signature of Parent/Guardian Date
Signature of Witness
Date