PAUL PASQUALONI FOOTBALL CAMP

2013
PAUL PASQUALONI
FOOTBALL CAMP
Anthony Sherman
Tyvon Branch
Dan Orlovsky
ONE DAY
HIGH SCHOOL CAMPS
June 1 | June 9 | June 15 | June 23
ONE DAY
YOUTH CAMP
Saturday, June 22
TEAM PASSING
CAMP
THREE DAY
OVERNIGHT CAMP
Sunday, June 16
Tuesday, June 25 - Thursday, June 27
PARENTAL CONSENT
I give my approval and consent to the participation of my son
hereinafter referred to as “Camp”.
in the Paul Pasqualoni Football Camp,
I am aware of the risks and hazards incidental to such participation and I certify that he is physically fit to take part in all activities. I will not hold Camp
authorities, Camp staff, or the Camp responsible in case of accident or injury as a result of his participation and hereby waive, release and forever
discharge any and all claims for damages which may hereinafter occur to him against the Paul Pasqualoni Football Camp and the University of Connecticut
or their respective officers, agents, representative, successors and/or assigns, for any or all damages which may be sustained or suffered by my son in
connection with his association with or participation in on the campus of the University of Connecticut as a result of my son’s participation in the Camp. I,
the parent or guardian do hereby agree to the above waiver and release.
Permission is granted to use his photograph in future Camp literature and publicity. I pledge his compliance to any and all Camp rules and understand that
he could be dismissed from Camp for any conduct not in the best interests of the camp and that no part of his registration fee will be refunded.
I hereby authorize any medical evaluation or treatment of my son that may be advised or recommended by the attending physician while at the Paul
Pasqualoni Football Camp. I understand that I am responsible for any medical expenses that may result from his participation.
Parent /Guardian Name
Email Address
Home Phone
Emergency Contact Name
Cell Phone
Emergency Contact Phone
Relationship
High School / Youth Organization
Roommate Request
Insurance Carrier
Policy #
Special Medical Concerns
Signature
Date
MEDICAL INFORMATION
Staff
Date of Physical Exam
Camper
Camp Session
Type of Camper [Check One]
Camper Name
Resident
Day
Date of Birth
May participate in all camp activities
May participate, except for
MEDICAL INFORMATION PERTINENT TO ROUTINE CARE AND EMERGENCIES
Is the individual taking prescription medication?
Yes
No
If yes, a separate Authorization for the Administration of Medications form must be filled out and returned with the completed physical. This form can
be found online at www.coachpasqualoni.com.
Does the individual have allergies?
Yes
No
If yes, please explain
Is the individual on a special diet?
Yes
No
If yes, please explain
The camper is up-to-date on all the following routine childhood immunizations currently recommended by the American Academy of Pediatrics and
National Advisory Committee on Immunization Practices:
Measles
Yes
No
Mumps
Yes
No
Diptheria
Yes
No
Rubella
Yes
No
Polio
Yes
No
Pertussis
Yes
No
Tetanus
Yes
No
Hepatitis B
Yes
No
Chickenpox
Yes
No
NAME OF MEDICAL CARE PROVIDER [Please Print]
Street Address
Telephone
City
Signature of Physician, APRN, or PA
State
Zip
Date
To enroll, complete and return these forms with a check or money order made out to the Paul Pasqualoni Football Camp.
2013 PAUL PASQUALONI FOOTBALL CAMP
CAMP SCHEDULE
ONE-DAY HIGH SCHOOL CAMPS
$45 Tuition
Donald Brown
Grades 9-12
Saturday, June 1, 2013
Sunday, June 9, 2013
Saturday, June 15, 2013
Sunday, June 23, 2013
From 1991 to 2004, Coach P served as the Head Football Coach
at Syracuse University, where he became the Big East Conference’s
all time winningest coach, which included 4 Big East Championships,
and 9 Bowl Appearances. Prior to being named the head coach at
Syracuse, Coach Pasqualoni spent four years as an assistant under
Coach Dick MacPherson.
ONE-DAY YOUTH CAMP
$65 Tuition
Grades 3-8
Saturday, June 22, 2013
Over his career at Syracuse, Coach P developed a wealth of NFL
talent, including 17 selections in the first three rounds and 7 first
round draft picks.
TEAM PASSING CAMP
$275 Per High School Team
High School Teams ONLY
Sunday, June 16, 2013
High school coaches MUST register their teams
Coach Pasqualoni is in his second season and is
the 28th head football coach in the history of the
University of Connecticut Football Program. The
Connecticut native joined the Huskies after serving
as the Defensive Coordinator of the Miami Dolphins
from 2008 to 2009 and the Defensive Coordinator
of the Dallas Cowboys in 2010. From 2005 to 2007,
Coach P served on the Cowboys staff as both the TEs
Coach and the LBs Coach.
Kendall Reyes
Please call 860-208-9420 for more information
THREE-DAY OVERNIGHT CAMP
$350 for overnight campers / $250 for commuters
Grades 5-8 & Grades 9-12
Tuesday, June 25 to Thursday, June 27, 2013
Team discounts available beginning at 10 campers from the
same high school or youth organization
Call 860-208-9420 for more information on team discounts
ATTENTION KICKING SPECIALISTS: Professional kicking instruction will be
provided at all One-Day High School Camps and the Three-Day Overnight Camp.
All camps are located on the Storrs Campus of the University of Connecticut
For more information logon to www.coachpasqualoni.com or call 860-208-9420
Coach P also served as an assistant coach at Cheshire HS (19721975), Southern CT State University (1976-1981), and Head Coach
at Western CT State University (1982-1986).
CAMP COACHES BY SCHOOL
Represented In Past Two Years
Princeton University
Anna Maria College
Sacred Heart University
Assumption College
Saint Lawrence University
Bates College
Salve Regina University
Bentley College
Southern Connecticut State University
Brown University
Stony Brook University
Central Connecticut State University
Towson University
Colgate University
Trinity College
College of the Holy Cross
Tufts University
Columbia University
University at Albany
Fordham University
University of Maine
Harvard University
University of New Hampshire
Lafayette College
University of New Haven
Lehigh University
University of Rhode Island
Maine Maritime Academy
Wagner College
Montclair State University
Yale University
Norwich University
CAMP INFORMATION
Deposit
Team Rates
$200 Non-Refundable for Overnight Camp
$45 Non-Refundable for One Day High School Camps
$65 Non-Refundable for One Day Youth Camp
Team discounts are available beginning at 10 campers from the same
high school or youth organization.
APPLICATIONS MUST BE TURNED IN TOGETHER TO RECEIVE THE TEAM
RATE. TEAM RATES ARE ONLY IN EFFECT WHEN CAMPERS ARE REGISTERED
TOGETHER AND AT THE SAME TIME.
Refunds
THERE ARE NO REFUNDS OF THE $200, $45, OR $65 DEPOSITS.
Only requests with proper medical documentation will be considered for a
refund after June 1, 2013.
College Staff
Head Coach Paul Pasqualoni and members of the University of Connecticut
Football Staff, plus CAA, Ivy League, Patriot League, and NESCAC coaches.
ALL REFUND REQUESTS MUST BE RECEIVED PRIOR TO THE START OF CAMP
What to Bring
Balance Due
All balances must be paid in full by May 15, 2013.
Helmet, cleats, sneakers, gym shorts, t-shirts (ALL CAMPS)
Fan, towels, toiletries, pillow, bed linens (OVERNIGHT CAMP ONLY)
Overnight Campers
Parking
$350 Tuition includes all meals and housing in the University of
Connecticut Dorms (no air conditioning).
All vehicles on campus are charged for parking. All vehicles must park in
the SOUTH PARKING GARAGE or LOT D. If campers and/or parents park
in any other places on campus they will be subject to ticketing or towing.
Commuter Campers
Payments
$250 Tuition includes dinner on the opening night of camp, and lunch
and dinner on the second day of camp.
Check In
Check Out
12:00PM on June 25, 2013
11:00AM on June 27, 2013
Questions?
Call 860-208-9420
|
Make checks payable to Paul Pasqualoni Football Camp, and mail to:
Paul Pasqualoni Football Camp
PO Box 561
Storrs, CT 06268
Visit www.coachpasqualoni.com
|
Email [email protected]
REGISTRATION INFORMATION [Please Print Clearly]
Future correspondence will be sent to the email address listed on the application. You may also register online at www.coachpasqualoni.com.
One Day High School Camps (Grades 9-12) $45
Saturday, June 1, 2013
Sunday, June 9, 2013
One Day Youth Camp (Grade 3-8) $65
Sunday, June 23, 2013
Saturday, June 15, 2013
One Day Team Passing Camp (HS Teams ONLY) $275 Per Team
Saturday, June 22, 2013
Please call 860-208-9420 to register
Three Day Overnight Camp (Grades 5-8 and Grades 9-12)
Tuesday, June 25 – Thursday, June 27, 2013 Overnight
Tuesday, June 25 – Thursday, June 27, 2013 Commuter
Camper First Name
Camper Last Name
Street Address
City
Date of Birth
State
Height
Weight
High School / Youth Organization
Grade Entering in Fall 2013 [Circle One]
Zip
Roommate Request
3
4
5
6
7
Primary Offensive Position [Circle One]
QB
TE
WR
RB
OL
Primary Defensive Position [Circle One]
DL
LB
CB
SAF
Specialist Position [Circle All That Apply]
P
K
LS
8
9
10
11
12