Niu Baseball "Top Dawg" Prospect Camp
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Insurance and Medical Care A member of the NIU Athletic Training Staff will be on call during camp activity sessions. NIU A parental authorization/release of information form is included and must be returned with the registration form. All insurance information must be complete or "Top Dawg" the camper will not participate. Baseball Prospect Camp All participants must have proof of medical insurance. Campers who do not have insurance will Saturday, September 22, 2007 be responsible for any medical payments. 9am-5pm Note: Camp includes much physical activity. NIU BASEBALL (8:30am check-in at Ralph McKinzie Field) Participants are encouraged to be properly "TOP DAWG" conditioned. If camp is rescheduled, notice will be posted at 815-753- PROSPECT CAMP nd 5300 at 6:00am on Saturday, September 22 Rules and Regulations WHO IS ELIGIBLE Campers must abide by the rules and regulations of This camp is designed for the serious high school Individuals grades 9 - 12 the Huskie Baseball Camps. Any serious violations, baseball player who intends to play baseball at the Enrollment is limited to 72 players. damage to NIU camp property, or other behavior collegiate level. The focus will be on improving deemed detrimental to the group will result in your skills and providing feedback that will assist CAMP FEE - $130 immediate dismissal. There will be no refund of fees you in your goal to play college baseball. ($25 cancellation fee) upon expulsion or upon voluntary withdrawal from Camp fee includes a camp t-shirt, written skill the camp. The camp training format will feature instruction assessment, NCAA compliance presentation, lunch, and quality collegiate level instruction. Registration Methods in hitting skills, fielding skills, stretching, Please complete the attached registration form and flexibility, and agility, long toss, and information LOCATION parental authorization/release of information form. If on the recruiting process. All baseball activities will be at Ralph McKinzie Baseball applicable, confirmation will be sent via email (check Field and at the Huskie Football Stadium on the Northern your spam folder) within 48 hours of registration In order to maximize baseball knowledge and Illinois University campus in DeKalb. Ralph McKinzie receipt. If email is not an option, confirmation will be exposure, camp instructors will include the Field is located on the corner of Stadium Drive West and sent through U.S. mail. Northern Illinois Baseball Staff, along with Stadium Drive North. Please park in lot PS. Please note: There is $25 cancellation fee coaches from other levels of college baseball, WHAT TO BRING Mail completed registrations to: current NIU players, and former NIU players in Campers should bring their own glove and appropriate professional baseball (if scheduling permits). practice attire. NIU Huskie Sports Camps 219 Convocation Center Parents are invited to observe the camp. QUESTIONS DeKalb, Illinois 60115 Please call 815-753-5300 or e-mail [email protected] with questions regarding registration, cancellation, or Online registration is available at general inquiries. www.niuhuskies.com For specific questions about baseball camp, Phone: 815-753-5300 call 815-753-0147. Fax: 815-753-7700 Online information is available at th Registrations must be received by September 14 www.niuhuskies.com CAMPER'S HEALTH FORM - REQUIRED REQUIRED To be completed by the camper's parent or legal guardian PARENTAL AUTHORIZATION/RELEASE OF INFORMATION NORTHERN ILLINOIS UNIVERSITY CONSENT TO TREATMENT CIRCLE YES/NO/NONE OR ENTER INFORMATION 2007 Top Dawg Baseball Camp LIMITATION AND WAIVER OF LIABILITY ALL INFORMATION MUST BE COMPLETED IN ORDER TO Mail Registration Form In partial consideration of our child’s acceptance into the Northern PARTICIPATE IN THE CAMP. Illinois Baseball Camp, I/we as parents of Camper's Name __________________________________ YES/NO Asthma YES/NO Convulsions/Seizures Camper's Name _________________________________ Parental Contact _________________________________ YES/NO Heart Disease YES/NO Bleeding Disorders do hereby agree to limit the liability of the Northern Illinois University YES/NO Diabetes YES/NO Rheumatic Fever Address ________________________________________ Sports Camps, Northern Illinois University, its employees, agents, officers, staff and physicians, to the coverage of YES/NO Head Injury/Concussions the medical insurance policy covering participants in the Northern City __________________ State _______ Zip __________ Illinois University Sports Camps as explained in this brochure, which Allergies to Drugs / NONE _____________________________ Home Phone ( )______________________________ we have read and understand. I/we further agree to waive all liability, except for loss caused by gross negligence, of the Northern Illinois Allergies to Foods / NONE_____________________________ Day Phone ( )_______________________________ University Sports Camps, the Board of Trustees of Northern Illinois University, its employees, agents, officers, staff and physicians, for Parent's E-mail ___________________________________ any accident, injury (including death), illness or other mishap which Current Medications / NONE____________________________ might befall the above-named camper while traveling to or from, or (for confirmation of registration) during his/her attendance at the Northern Illinois University Sports Chronic or Recurring Illnesses / NONE____________________ Camps, which is not covered by said medical insurance policy. PRIMARY POSITION ___________________________ Further, I/we hereby grant permission to the staff and physicians Operations/Injuries (including dates) / NONE_______________ of Northern Illinois University, and medical or surgical consultant SECONDARY POSITION____________________ deemed advisable, and any hospital to render to the above-named ___________________________________________________ camper any medical and surgical treatment that they deem necessary. I/we understand that all possible effort will be made to GRADE: FR SO JR SR inform me/us in case of such treatment. Physical Restrictions / NONE___________________________ This health history is correct to the best of my/our knowledge and my/our son/daughter has my/our permission to participate in camp Physician Name ______________________________________ AGE: 15 16 17 18 activities with the exception of those noted under physical restrictions. Physician Telephone __________________________________ I authorize Kishwaukee Community Hospital, University Health ADULT T-SHIRT SIZE: S M LG XL Service and the DeKalb Clinic to release medical information regarding the above named participant to interested parties including Camper's Date of Birth _______/_______/_______ School ________________________________________ parents and family physician. Insurance Information - REQUIRED ___________________________________________ "Top Dawg" Baseball Camp - 9/22/07 PARENT OR LEGAL GUARDIAN'S NAME (printed) (MUST ATTACH COPY OF INSURANCE CARD) Insured Name ________________________________________ $130 Fee ___________________________________________ SIGNATURE Name of Company ____________________________________ 10% NIU Employee Discount ($117) _______/_______/_______ DATE Address _____________________________________________ There is a $25 cancellation fee Please enclose special accessibility accommodation request(s) ( )_____________________________________ Policy Number _______________________________________ PHONE: Day Total Amount $ __________ (checks payable to NIU) ( )_____________________________________ Phone Number _______________________________________ PHONE: Emergency To pay with a credit card, please register online A doctor's release must be attached if camper is recovering ( )_____________________________________ from a recent illness or injury, or if he/she will be at: PHONE: Cell participating with a cast or splint. www.niuhuskies.com .