VOLLEYBALL PROSPECT CAMP

FORM DETAILS




Camp roster is FULL! We not accepting registrations at this time.

If you have questions, please contact Ruth McGolpin at rmcgolpin@westmont.edu.
July 12-14, 2024

Camp roster space is limited!

To reserve your spot submit this registration form as soon as possible!
Players must be current 10th, 11th or 12th grade high school or college transfer students.

If you have questions, please contact Ruth McGolpin at rmcgolpin@westmont.edu.

STUDENT CONTACT INFORMATION









PARENT INFORMATION




SECONDARY PARENT/GUARDIAN




ACADEMIC INFORMATION


YYYY



COLLEGE INFORMATION

Will you enter college as a First Year or as a Transfer?

When do you plan to begin your college education?
ROSTER INFORMATION







PAYMENT DETAILS












LIABILITY WAIVER

Consent for Event Activities and for Treatment
PARTICIPANT



EVENT INFORMATION

MEDICAL INFORMATION
Leave blank where not applicable.





PARENT/LEGAL GUARDIAN
If Participant a minor; preferred contact otherwise.










MEDICAL PROFESSIONAL




AUTHORIZED ADULTS
CONTACT ONE




CONTACT TWO




Authorization for Medical Care
If an injury or illness requires, in the opinion of the person in charge, urgent medical or dental examination or treatment, I authorize and direct that person (or their agent) to:
a) arrange transportation by car or ambulance to the closest hospital;
b) call the Medical Professional/s named above; and
c) attempt to reach one or more of the other listed contacts.
If a named Medical Professional is unavailable, I authorize any emergency treatment deemed necessary by a medical professional licensed for the required service.

Acceptance of Circumstances & Assumption of Risk
I understand that Westmont College assumes no financial responsibility or legal liability for medical care or ambulance transportation. I also verify that the Participant is in sufficient health to be able to participate in the event identified above. I recognize that all physical activity has some risk of injury.

Image Release
I authorize the use, in future program publications, of biographical, image, video or audio content recorded for or during event activities and include this Participant.

Acceptance of Circumstances & Assumption of Risk
I understand that Westmont College assumes no financial responsibility or legal liability for medical care or ambulance transportation. I also verify that the Participant is in sufficient health to be able to participate in the event identified above. I recognize that all physical activity has some risk of injury.

Image Release
I authorize the use, in future program publications, of biographical, image, video or audio content recorded for or during event activities and include this Participant.

Electronic Signatures
A signed copy of this waiver submitted via this form shall be deemed to have the same legal effect as delivery of an original executed copy of this waiver for all purposes.
SIGNATURE