2020 MEDICAL RELEASE FORM**Complete and return this form with camp application**

Consent to Medical Treatment & Release of Liability(Read this before signing below)

Parent/Guardian shall hereby release, hold harmless and indemnify the Florida Gulf Coast University Board of Trustees, and Florida Gulf Coast University and its officers, employees and agents, for and against any and all liability claims, charges,damages, demands, expenses, fees, fines, penalties, losses, suits, proceedings,actions, and costs thereof (including attorney fees and court costs for all actions and appeals therefrom), judgments, injuries, damages or liabilities, in law or in equity, of any kind and nature resulting from or arising out of an illness or injury related to my child’s acts or omissions while a participant in the 2020 FGCU Volleyball Camps.

To the best of my knowledge, I/my child am/is in good physical condition and I am not aware of any physical infirmity which would place me/my child at risk to participate in any way with camp activities. I am fully aware of risks and hazards connected with the camp. I voluntarily assume full responsibility for any risk of loss, property damage, or personal injury, including death, that may be sustained by me/my child, or any loss or damage to property owned by me/my child as a result of being engaged in the camp’s activities, whether caused by the negligence of the release or otherwise. I further here-by agree to indemnify and hold harmless the release from any loss, liability, damage, or cost, including court costs and attorney’s fees, that may accrue related to me/my child’s participation in this camp, whether caused by the negligence of the release or otherwise.

During the period of the camp, I hereby give permission for the staff of Florida Gulf Coast University or this camp to administer appropriate medical attention to me/my child in the event of an accident, illness or injury. I will be responsible for any and all costs of medical coverage and treatment provided not covered by insurance.

It is my express intent that this Waiver of Liability and Hold Harmless Agreement shall bind the member of my family and my spouse, if I am alive, and my heirs, assigns and personal representative, if I am deceased, and shall be deemed as a release, waiver, discharge and covenant not to sue the above named release.

I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be construed in accordance with the laws of the State of Florida. In signing this release, I acknowledge and represent that I have read and understand it and sign it voluntarily; I am at least eighteen (18) years of age and fully competent; and I execute this release for full, adequate and complete consideration fully intending to be bound by the same.

I release and forever discharge and covenant not to sue the Florida Gulf Coast University Board of Trustees, Florida Gulf Coast University and their officers, agents, employees, and representatives (“Releases”) from and against any and all liability for any and all claims, demands, actions, causes of action of whatever kind or nature, costs and expenses of any nature, including attorneys’ fees (“Claims”) that I may have or that may hereafter accrue to me or my Child, arising out of or related to any harm, loss, damage, or injury including, but not limited to suffering, death, or property loss that may be sustained by my Child, whether caused by his/her action, or the negligence of the Releases or the action of third parties in connection with the Activity. I also agree not to sue Releases in connection with any such harm, loss, damage, or injury. I agree to indemnify and hold Releases harmless from any against all claims asserted against any of the Releases by any entity based upon my Child’s participation in the Activity.

I HAVE READ THIS WAIVER OF LIABILITY AND FULLY UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Parent/Guardian Signature Date Signed

Campers Name (Print)

Medical Insurance Company Name

Policy Number Group Number

Insurance Company Phone Number Insured’s Name 2020

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ATTACKING CAMPATTACKING DAY CAMP (JULY 6, 2020) (ADC)Deposit: $100.00 (Non-Refundable) | Commuter: $135.00 | Ages: 8-18Check In: 9:30AM – 10:00AM | Check Out: 5:15PM**Lunch NOT included** | **64 Spots (open to all based on availability)**

ATTACKING/SERVING DAY CAMP (JULY 28, 2020) (ASDC)Deposit: $100.00 (Non-Refundable) | Commuter: $135.00 | Ages: 8-18Check In: 9:30AM – 10:00AM | Check Out: 5:15PM**Lunch NOT included** | **64 Spots (open to all based on availability)**

BALL HANDLING / 1ST CONTACT CAMPBALL HANDLING/1ST CONTACT DAY CAMP (JULY 7, 2020) (BHFC)Deposit: $100.00 (Non-Refundable) | Commuter: $135.00 | Ages: 8-18Check In: 9:30AM – 10:00AM | Check Out: 5:15PM**Lunch NOT included** | **64 Spots (open to all based on availability)**

ALL SKILLS CAMPSOVERNIGHT ALL SKILLS CAMP (JULY 10 – 12, 2020) (AS1)Deposit: $200.00 (Non-Refundable) | Commuter: $325.00 | Resident: $380.00Blue Group Ages: 9-13 | Green Group Ages: 14-17Blue Group Check In: 11:00AM – 12:00PM (July 10)Green Group Check In: 1:00PM – 2:00PM (July 10)Blue Group Check Out: 3:00PM - 4:00PM (July 12)Green Group Check Out: 5:00PM - 6:00PM (July 12)

BOOT CAMP / ALL SKILLS DAY CAMP (JULY 14, 2020) (AS2)Deposit: $100.00 (Non-Refundable) | Commuter: $135.00 | Ages: 8-18Check In: 9:30AM – 10:00AM Check Out: 5:15PM **Lunch NOT included** | **64 Spots (open to all based on availability)**

OVERNIGHT ALL SKILLS CAMP (JULY 17 – 19, 2020) (AS3)Deposit: $200.00 (Non-Refundable) | Commuter: $325.00 | Resident: $380.00Blue Group Ages: 9-13 | Green Group Ages: 14-17Blue Group Check In: 11:00AM – 12:00PM (July 17)Green Group Check In: 1:00PM – 2:00PM (July 17)Blue Group Check Out: 3:00PM - 4:00PM (July 19)Green Group Check Out: 5:00PM - 6:00PM (July 19)

TEAM CAMPOVERNIGHT TEAM CAMP (JULY 24 – 26, 2020) (TC)Deposit: $200.00 (Non-Refundable) | Commuter: $350.00 | Resident: $300.00Check In: 1:30PM – 2:30PM (July 24th)Check Out: 3:00PM - 4:00PM (July 26th)15 Teams

TEAM CAMP DESCRIPTIONThis camp is tailored toward high school programs looking for an opportunity to train as a team in advance of their season. There will be an emphasis on team systems and concepts while also incorporating individual skills training within the sessions. With feedback from each team’s respective coaches (who are encouraged to attend) we will personalize the training focus to reflect the needs of each group. The environment is fast paced, repetition intensive, and constructive. Camp will conclude with tournament play. Campers must bring their own breakfast foods. Lunch and Dinner will be served at Alico Arena in the VIP Room.

* Note: All camps and clinics are open to any and all entrants regardless of skill level (limited only by number, age, grade level and/or gender). All individuals signing up for team camp must be affiliated with a registered team.

CAMPERS SHOULD BRINGAppropriate shoes and volleyball training clothes; knee pads. Also bring all your things that you will need to sleep over in the dorm rooms, including bedding for a twin bed.

This year only lunch and dinner will be provided, so please bring breakfast snacks for your dorm rooms. All rooms are equipped with a full kitchen.

CAMPERS ARE EXPECTED TO:Act with respect for themselves, other campers, staff, and the campus of Florida Gulf Coast University. Campers who cannot behave in a mature manner could be expelled from camp without a refund.

LOCATIONAll check-in’s and outs, camps and sessions will be held on the campus of Florida Gulf Coast University at Alico Arena. All campers will be staying at the on campus housing called North Lake Village. All camp times are subject to change.

FOODArtichoke & Company, a delicatessen and full service catering company, will provide all lunches and dinners during the camps. For further information please check out their website or contact Brian Gorman at the number below.Website: www.ArtichokeAndCompany.com | Phone: 239.263.6979

EMERGENCIESContact Stephanie Zielinski in the FGCU Volleyball Office of at 239.590.7223or 954.461.4272.

MATT BOTSFORDFGCU DIRECTOR OF VOLLEYBALL

• Reigning ASUN Coach of the Year

• Current FGCU head coach for indoor volleyball

• Lead FGCU to Back to Back ASUN Championships in 2018 and 2019

• Lead FGCU to ASUN Tournament Champions and second round in the NCAA Tournament in 2018

• FGCU Volleyball is ranked 11th in the nation in total wins over the last four years

STEPHANIE ZIELINSKIASSISTANT VOLLEYBALL COACH

• Current Recruiting Coordinator at FGCU

• 5 years of collegiate coaching experience

• Competed 2 years as a professional volleyball player in Switzerland

• 2nd all-time assist leader at Rutgers University

FGCU VOLLEYBALL CAMP APPLICATION

CAMPER INFORMATION

Name : _______________________________________________________________________

Address: _____________________________________________________________________

City: _________________________________________________________________________

State: _______________________________________ Zip: ____________________________

Grade Entering Fall 2020: ____________________Age: ____________________________

School: ______________________________________________________________________

Club Team: ___________________________________________________________________

PARENT/GUARDIAN INFORMATION

Name(s) : ____________________________________________________________________

______________________________________________________________________________

Home Phone: _________________________________________________________________

Cell Phone: ___________________________________________________________________

Email: ________________________________________________________________________

CHECK ALL THAT APPLY

ADC ASDC BHFC AS1 AS2

AS3 TC COMMUTER RESIDENT

CHECK SHIRT SIZE

SMALL MEDIUM LARGE X-LARGE

MAKE ROOMMATE REQUESTS BELOW | UP TO 4 IN A ROOM

1) ____________________________________________________________________________

2) ____________________________________________________________________________

3) ____________________________________________________________________________

CAMP STAFF

REGISTER NOW. SPACE IS LIMITED!!! Sessions are filled on a first-come, first served basis.

SIGN UP ON LINE AT: FGCUVOLLEYBALLCAMPS.COM

OR FILL OUT THE APPLICATION & MAIL IT WITH A DEPOSIT TO:Florida Gulf Coast University,

10501 FGCU Blvd. South, Fort Myers, FL 33965Attn: Stephanie Zielinski

Make Check Payable to: Florida Gulf Coast Volleyball, LLC

*DEPOSIT IS NON-REFUNDABLE*

CAMP DETAILS