M MMMo oool lllt ttte eeen nnn V VVVo oool llll llle eeey yyyb bbba aaal llll lll C CCCa aaam mmmp ppps sssS SSSp pppr rrri iiin nnng ggg C CCCl llli iiin nnni iiic ccc 6 666t ttth hhh – ––– 8 888t ttth hhh G GGGr rrra aaad ddde eee B BBBo oooy yyys sss a aaan nnnd ddd G GGGi iiir rrrl llls sss 6-Week Session Fundamental Volleyball Training for Athletes of All Levels Tuesdays: May 4th – June 8th 5-7 PM OR Thursdays: May 6th – June 10th 5-7 PM $80 for 12 Hours of All Skills Instruction Cost includes coach salary, court rental, secondary insurance, and clinic t-shirt. All Skills Clinics will be held at: Sports Advantage Center 807 Parkview Rd Ashwaubenon, WI 54304 Mail Registration Form with check or money order payable to: Molten Volleyball Camps 807 Parkview Rd Ashwaubenon, WI 54304 Each clinic must have a minimum of 6 athletes to proceed. Registration deadline is April 30. Contact Tony Larocca with inquiries by email at tony.pedgewi@gmail.com or by phone, 608-217-6531 MVC All Skills Clinic Spring Clinics Registration Form Please Print Clearly Athlete Information: Name: _________________________________________________ Birth Date: _______________ Entering Grade: ________________ Phone: _________________________________________________ Address: _______________________________________________ Email: _________________________________________________ Check here [ ] if you would like to be excluded from our email list for future events and activities. T-shirt Size (Adult sizes): ____________ Registration for Clinic: (‘X’ as necessary) 5-7 PM: Tuesdays _______ or Thursdays _____ 2010 Molten Volleyball Camps’ Liability Waiver I, the undersigned, have adequate insurance and am/are willing to take full financial responsibility for any and all injuries sustained by my son/ daughter/legal ward, ____________________, while participating in camp/clinic/league activities. I further knowingly and voluntarily waive any and all claims against and forever release the camp/clinic/league, its employees, Molten Volleyball Camps, and Club Fusion, Inc. My insurance carrier is __________________________________________________ Policy Number _________________________________________________________ Emergency Contact _____________________________________________________ Phone Number _________________________________________________________ My signature below will allow a coach or designated person to admit my son/daughter/legal ward to a medical facility and/or to the care of a physician, if conditions warrant such action. First notification will be to the emergency contact listed above. Parent / Legal Guardian Signature Date Parent / Legal Guardian Printed Name Clinic Fee: $80 Payable to: Molten Volleyball Camps Mail registration to: Molten Volleyball Camps, 807 Parkview Rd, Ashwaubenon, WI 54304