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REGISTRATIONThis form must be lled out and signed by the
appropriatepeople and mailed to Jessica Stevenson before
participation
in the camp will be allowed. Upon receiving the completed
application form and payment, a conrmation email will be
sent
to the email address documented.
About Kamp Kooi:
Kamp Kooi is a two day event held July 29th and 30th, 2013
from 8:00 to 11:00 am. at the Hinton Elementary School. Kamp
Kooi is open to any student enrolled in the 3rd to 8th grades
as
of August 2013. Cost for the camp is $55.00.
Method of Payment
(Checks payable to Jessica Stevenson)
5Check5CashCamper
Name:______________________________________
School:____________________________________________
Grade in Aug 2013: __________________________________
Address:___________________________________________
City / State / Zip: ____________________________________
Cell Phone:_________________________________________
Home Phone: _______________________________________
Daytime Phone: _____________________________________
Email:_____________________________________________
T-shirt Size:
5Adult Small5Adult Medium5Adult Large 5Adult X-LargeEmergency
Contact Information
Name: ____________________________________________
Relationship: _______________________________________
Phone(s):__________________________________________
JessicaStevenson
Attn:KampKooi
315LakeshoreDr
NorthSiouxCity,
SD57049
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HEALTH & CONSENTThe following medical treatment form MUST be
completedand SIGNED by the parent/guardian to enable the camper
to
participate.
As parent/guardian, I hereby authorize the camp staff at
Kamp Kooi to act for me according to their best judgment in
any emergency requiring medical attention, and I release the
staff as well as the High Schools from any and all liability
for
injuries, illnesses, or lost property incurred while the
above
named camper is at camp. I understand the risks involved in
participating in athletics, such as volleyball, which can
include
serious injury or death. I hereby grant permission for the
above named camper to participate in the 2013 Kamp Kooi
Volleyball Camp and if an injury should occur during,
traveling
to or returning from the camp, I agree to pay for all costs,
present and future, through my medical insurance policy and/
or personal nances. I have no knowledge of any physical
condition that would be affected by the above named campers
participation in the camp. I have attached any relevant
medical
information. Kamp Kooi retains the rights to use photographs
of campers taken at camp for publicity and/or advertising
purposes. By signing below, I consider this document to be
legally binding.
Parent/Guardian Signature:____________________________
Phone: ____________________________________________
Date: _____________________________________________
Medical: ___________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
Mail to:
Jessica Stevenson
Attn: Kamp Kooi315 Lakeshore Dr
North Sioux City, SD 57049
Thanks for considering Kamp Kooi! After years of competing
both professionally and collegiately, Jessica wanted to
bring
back to her hometown and neighboring schools what she had
learned throughout the years. With the help of her sister,
Jamie,Jessica hosted her rst set of camps during the summer of
2009 in Kingsley, Iowa. Over 80 campers attended Kamp Kooi
that year. In the following years, Kamp Kooi expanded to
include
Kingsley, Hinton and Sergeant Bluff school districts. Jessica
and
her team of coaches annually train close to 200 area
athletes.
Volleyball is a passion of Jessicas and Kamp Kooi works to
instill that same passion into their players.
2013 KAMPCamp will be held July 29th and 30th, 2013 at the
Hinton
Elementary School from 8:00-11:00 am. Kamp Kooi is open to
any student enrolled in the 3rd to 8th grades as of August
2013.This camp is designed to teach players the fundamentals of
volleyball. Players will be drilled in all skill areas including
setting,
blocking, serving, attacking, and individual defense. In
addition,
team offensive and defensive systems will be incorporated.
Players will receive the best instruction from current and
former collegiate volleyball players and coaches. In addition,
all
campers will receive a T-Shirt if form and payment are
received
by Friday, July 5th. We look forward to seeing you in camp!
For more information contact Jessica at:
712.253.4493email: [email protected]
facebook.com/kampkooi
ABOUT KAMP KOOI
