MEDICAL INFORMATION In the event o f illness or injury req uiring treatmen t, hospitalization and/or surg ery, family medical insurance must be used. The Performance camps do not provide medical insu rance for p articipants . HEALTH AND LIABILITY FORM PENFIELD PERFORMANCE VOLLEYBALL CAMP FOR BOYS 2015 Participant s name: ___________________ Parent/ Guardian s name _____________________ Street Address Home phone number_____________________ Emergency phone number________________________________ List any physical conditions that the Performance staff or a physician should be aware of (i.e. allergies, reoccurring illnesses, disabilities, chronic illnesses etc). In case of injury, I understand I will be contacted during the child s examination in the emergency department. If I am not available please contact: Name:____________________________Phone:__________ Physician:_________________________Phone:__________ Insurance Co:____________Subscriber Name:____ Subscriber ID#:__________ Plan #:_______ Check us out at: www.penfieldperformancevolleyballcamp.com Group#:______ In the event that I am unavailable for purposes of providing parental consent, I hereby authorize the Performance camp staff at the host facility ( Penfield Central School District), or a physician to provid e such hos pital care that prov ides the p roper pro cedures an d treatment s as pertain to my child s situation. I understand that the consent and authorization does not includ e major surgical procedures and is valid only during the time my child is participating in the Performance camp. I understand that neither the Performance camp staff nor Penfield Central School District provides medical insurance for participants, and in the event that treatment, hospitalization and/or surgery is needed, our family insurance shall be used. I further represent that such insurance is in effect during my child s participation in the Performance camp. I hereby waive and release the Performance camps and the Penfield Central School District from any and all liability for any injuries incurred by my child while attending camp. PARENT SIGNATU RE_____________________Date______ For boys entering grades 7-12 Tenative dates JULY 13 th - JULY 17 th PENFIELD HIGH SCHOOL AND BAY TRAIL MIDDLE SCHOOL 1:00 PM -7:00 PM SPONSORED BY THE PENFIELD PATRIOTS SPORTS BOOSTERS ABOUT THE CAMP SPONSORED BY THE PENFIELD PATRIOTS SPORTS BOOSTERS -Are you looking for a high intensity, quality volleyball camp at a reasonable price? -Are you looking to improve your game for the up-coming season? -Are you interested in taking your game to the next level? THEN THE PERFORMANCE VOLLEYBALL CAMP IS FOR YOU! Our camps are designed to provide the player with the optimum opportunity to learn, refine and develop their game, taking it to the next level. Under the guidance of highly successful coaches and players from around Section V and from the collegiate level, YOU can reach the next level! The 5 day camp will be high intensity, high level learning directed to help each player to take that next step. Players will be grouped according to ability and then given concentrated teaching to push each player at their own developmental speed. This camp is NOT just a play camp...we emphasize skill development while competing. CAMP INFORMATION: Camp dates: July 13th-17th Times: 1:00 PM- 7:00 PM What do I get for my enrollment cost? - 25 hours of on court training from outstanding coaches and players - Personal attention to skill detail with an 8:1 player to coach ratio -Limited Edition Long Sleeve Dry Fit Shirt, a Molten Backpack, The Camp Hoodie ( New!) Molten Pro Touch Volleyball or the Official NCAA Mens Volleyball! - An opportunity to compete for prizes ( volleyballs, logo shirts ) REGISTRATION FORM Participant s name____________________________Participant s age_________ E-mail address (*Required):______________________________________ Tee shirt size: (circle one: S M L XL) All campers receive this Please check off ONE gift (see website for more details) Long Sleeve Dry Fit Shirt (Redesigned for 2015) S M L XL Hoodie (Redesigned for 2015) S M L XL Molten Backpack Molten Pro Touch Volleyball Molten Men s NCAA Volleyball Camp dates: JULY 13th-17th Before May 15th : 200.00 ( Early bird special ) After May 15th : 210.00 Make checks or money orders payable to: Penfield Patriots Sports Boosters Club * Payment due in full with registration * There is a 50 dollar cancellation fee * No refund will be given for any cancellation within 21 days of the start of the camp. * No refund shall be issued for any medical condition that occurs within the refund time p eriod or occurring outside of cam p hours. * A portion of the proceeds go to the Penfield Sports Boosters Club Mail payment + Registration/Health form to: Michael Fusare 6 Chamberlain R oad Questions? Honeoye Falls NY 14472 Phone # 585-749-3161 E-mail [email protected] NOT E: All informa tion must be filled out on bo th sides for the ch ild to participa te!! OTHER INFORMATION Parent by signing this form agrees to assume full responsibility for any damages to property as a result of my child s actions while at camp. Parent also agrees to reimburse the Penfield Central School District for said d amage s. The Pe nfield Volleyb all camps are NO T respo nsible for lo st or stolen items. Dinner is not provided, please bag a dinner o r provide money to yo ur child to purchase a dinner. Parent signature______________________________Date:______ THE COACHING STAFF MIKE FUSARE Penfield Boys Varsity Volleyball Coach Founder and Director of Penfield Performance Volleyball Camps Head Coach, Penfield Boys Varsity Volleyball program, 1995present 2009 NYS Champions 2000, 2006, 2007, 2008, 2 009 Class A Section V champions 2004, 2005, 2012, 2104 Class A Section Finalist 1998,2000,2002,2004, 2005, 2007, 2008,2009 Division Champions Career Record 347-83 1998, 2000, 2003, 2011, 2 014 Class A Coach of the Year 2007, 2011 AGR Coach of the Year 2009 Nominee for National High School Coach of the Year ETHAN DANGLER Penfield Varsity Assistant Coach 2013-present 2012 All Greater Rochester selection 2012 1st Team All County Assistant Coach Victor 17s RICH NEWTON West Irondequoit Boys Varsity Coach 2010-present Head Coach Pace 16-1s ranked nationally 2014 Class B Coach of the Year 2014 Class B Finalist Collegiate player at Divisi on II Lees McCrae College Member of 1998, 2000 Class A Division II champions Member of 2000 Class A Section V champions Penfield Penfield Boy s J V Coach Career record 69-3 NICK MICKOL Penfield Junior Varsity Head Coach 2010-present Career record 85-3 Member of 2004. 2005 Penfield Class A finalists Victor Volleyball club 17s coach THE COACHING STAFF CHRIS PARKS AARON AUSTIN Head Coach McQuaid Boys 2010, 2011, 2012 Class A NYS Champions 2004, 2005, 2010, 2011, 2012, 2014 Boy's Sect ion V Champions 2003,2006, 2008, 2009 Class A Section V finalist 2010, 2012 AGR Coach of the Year 2004 Class A Coach of the Year City-Catholic League Champions 1994-2007 Pittsford Sutherland Girl's Varsity Coach 2005 Head Coach, Spencerport Boys Varsity 2006-present 2013 Class B Coach of the Year Former player at Fredonia 19992003 Assistant Coach with Fredonia Women 1999-2002 First team all-count 1997-1998 Former Pace player 1988-1998 SAM BITTKER Collegiate player at Nazareth College Form Penfield High School Varsity Player 2013 All Greater Rochester selection 2012 1st Team All County Member of Performance camp staff 2011-present TED BRAZENER Member of 1994 Penfield Class A Champions Former All County player at Penfield Assistant Coach Penfield Boys 2007-present 2007, 2008, 2009 Class A Section V champions FRANK CLARK Former Head Coach Victor Boys Volleyball Former Head Coach Fairport Girls Varsity Current Head Coach Victor Boys Junior Varsity Head coach Victor Boys 15-1 Coaching clinician in local boys volleyball camps Typica l day ( ex cluding a portion o f day #1 & day #5 for skill evaluation and closing activities ) 1:00-1:10 Warm up 1:10-1:20 Competitive warm up 1:20-1:30 Skill #1 demonstration 1:30-2:00 Work within levels + Competitive drill work 2:00-2:15 Skill #2 demonstration 2:15-2:55 Skill work within levels + Competitive drill work 2:55-3:55 Wash drills applying Skills 1+2 3:55-4:55 Lunch Break 4:55-5:10 Competitive warm up 5:10-5:30 Review and apply skills 1 & 2 in competitive drills 5:30-5:50 Team concept #1 5:50-6:15 Apply concept in wash drill 6:15-6:25 Team concept #2 6:25-6:45 Apply team Concept # 2 6:45-6:55 Competitive 6 on 6 wash drill applying learned concepts 6:55-7:00 Cool down For more information and pictures of the gifts go to www.penfieldperformancevolleyballcamp.com CAMP OVERVIEW Players that attend the Performance Volleyball Camp will come away with a greater, more complete understanding of not only the skills of the game, but of what it takes to compete at the next level. The staff of the Performance camp is composed of coaches that not only know how to teach, but how to compete. During their 25 hours of training and competing, the participants will be exposed to a variety of teaching techniques as well as innovative types of competition. These are NOT repetition driven, grind it out camps, rather they are an up beat, positive learning experience. This past year, the camp filled to capacity well before May. Do not delay in getting your application in! Check our Website out for more details: www.penfieldperformancevolleyballcamp.com ASK ABOUT OUR SIBLING DISCOUNT!!
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