1. Healthcare

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!!