Child s Name Please Print (One form Per Student) Grade T-Shirt Size Please use grade your student will be in the 2018-2019 school year for selecting camp times. Please check one. GRADE ENTERING NEXT YEAR Youth Small Youth Medium Youth Large Small Medium Large Ex-Large Emergency Contact Information Mother s /Guardian Name Father s /Guardian Name Mother s/guardian Daytime Phone Number Father s/guardian Daytime Phone Number Address Address Email Email Camps Attending Please check all that apply Boys Soccer Boys Track Boys Basketball Baseball Wrestling Football Golf Boys Tennis Girls Soccer Girls Track Girls Basketball Softball Cheer Dance Volleyball Girls Tennis
Parent s Release I, the undersigned parent/guardian of the individual named above, a minor, do hereby agree to participate in the aforementioned activity and authorize and appoint the program directors and/or instructors as Attorneys in Fact and agents for the undersigned to consent to medical, surgical and/or dental examinations, in addition to any and all other treatments that may be deemed necessary by medical personnel. It is understood that participation involves an element of risk and a danger of accidents. Knowing those risks, I hereby assume those risks. In additional, I understand that by signing this agreement, I hereby release and discharge the Papillion- LaVista School District from any and all liability resulting in injury associated with the camper s participation in this activity. I understand it is my responsibility to inform camp personnel of any medical conditions, allergies, food restrictions or any other special needs my son/daughter may have. In the absence of a parent/guardian s signature below, payment of fees and participating in the program shall constitute acceptance of the conditions set forth in the release. I further grant the Papillion-LaVista School District and its employees the right to photograph or video my dependent and use the photo/video or other reproduction of his/her likeness for publication processes, whether electronic, print, digital or internet. Parent Signature Date Payment A separate check is NOT required for each camp. Make check payable to PLHS. Please include this form with check. Registration will remain open until the first day of the camp. After the first day of the camp, contact the coach regarding registration. Please mail payment and this form to PLHS, Attention: Athletic Office, 402 E. Centennial Road, Papillion, NE 68046. Baseball Nate McCabe nmccabe@paplv.org Dates Time Location Grades Cost Monday, June 4 -Thursday June 7 11:30AM-12:30PM Fricke Field (Halleck Park) K-2 $50 Monday, June 4 -Thursday June 7 8:00-9:30AM Fricke Field (Halleck Park) 3-6 $50 Monday, June 4 -Thursday June 7 10:00-11:30AM Fricke Field (Halleck Park) 7-9 $50
Boys Basketball Dan Moore dmoore@paplv.org Dates Time Location Grades Cost Tuesday, May 29 - Friday, June 1 8:00-9:30 AM PLHS North & South Gym 2-5 $50 Tuesday, May 29 - Friday, June 1 10:00-11:30 AM PLHS North & South Gym 6-8 $50 Tuesday, May 29 - Friday, June 1 12:30-2:30PM PLHS North & South Gym 9-12 $50 Girls Basketball Josh Siske jsiske@paplv.org Dates Grade Cost Monday, June 11-Thursday, June 14 8:00AM-10:00PM PLHS North 6-8 $50 Monday, June 11-Thursday, June 14 10:30AM-12:00PM PLHS North 2-5 $50 Monday, June 11-Thursday, June 14 1:00PM-3:00PM PLHS North 9-12 $50 Cheerleading Leigh McAuliff lmcauliff@paplv.org Monday, June 4 - Wednesday, June 6 1:00-3:00PM PLHS North Gym K-8 $40 Dance Camp Vern Davis vdavis@paplv.org Monday, June 11-Thursday, June 14 1:00-3:00PM PLHS South Gym K-8 $50
Football Randy Huebert rhuebert@paplv.org Monday, July 16-Friday, July 20 9:30-11:30 AM PLHS-Monarch Complex SW Side of PLHS-Turf Field Monday, July 23 Thursday, July 26 8:00-10:00 AM PLHS-Monarch Complex SW Side of PLHS-Turf Field Monday, July 23 Thursday, July 26 10:00AM-12:00PM PLHS-Monarch Complex SW Side of PLHS-Turf Field 9-12 $50 3-5 $50 6-8 $50 Boys & Girls Golf Joe Pudenz jpudenz@paplv.org Monday, June 25 Thursday June 28 8:00-10:00AM Eagle Hills Golf Club 3-5 $60 Monday, June 25 Thursday June 28 10:00AM-12:00PM Eagle Hills Golf Club 6-8 $60 Tuesday, May 29 th - Friday, June 1 st TBA Eagle Hills Golf Club 9-12 $60 **** 9th-12th grade sign-up deadline is May 15th **** Boys Soccer Girls Soccer Andre Watts April Kelcher awatts@paplv.org akelcher@paplv.org Monday, June 18-Thursday, June 21 8:00-9:30AM PLHS-Monarch Complex-SW Side 3-8 $50 Monday, June 18-Thursday, June 21 10:00-11:30 AM PLHS-Monarch Complex-SW Side 9-12 $50 Softball Todd Petersen toddpetersen0853@gmail.com Monday, June 4-Thursday, June 7 10:30-12:30PM La Vista City Fields - 78th and Josephine Monday, June 4-Friday, June 8 8:00-10:00AM La Vista City Fields - 78th and Josephine 3-8 $50 9-12 $50
Boys & Girls Tennis Mariana Hurst Chaz Zurcher Greg Classen mhurst@paplv.org czurcher@paplv.org Monday, June 18-Thursday, June 21 8:00-9:00AM PLHS Tennis Courts(courts 4-6) K-3 $50 Monday, June 18-Thursday, June 21 8:00-9:00AM PLHS Tennis Courts(courts 1-3) 4-6 $50 Monday, June 18-Thursday, June 21 9:00-10:00AM PLHS Tennis Courts(courts 4-6) 7-9 $50 Monday, June 18-Thursday, June 21 9:00-10:00AM PLHS Tennis Courts(courts 1-3) 10-12 $50 PLHS Doubles Camp Monday, June 18-Thursday, June 21 10:00-11:00AM PLHS Tennis Courts(courts 4-6) 7-9 $50 Monday, June 18-Thursday, June 21 10:00-11:00AM PLHS Tennis Courts(courts 1-3) 10-12 $50 Boys Track Camp Joe Pilakowski Garrett O Dell Bruce Nissen jpilakowski@paplv.org godell@paplv.org bnissen@paplv.org Tuesday, June 12-Thursday, June 14 Friday, June 15 11:00AM-12:30PM 12:30-2:00 pm PLHS Track-NW side PLHS 5-9 $50 Volleyball Ashley Beccard akfeek@aol.com Tuesday, May 29-Friday, June 1 8:30AM-10:00AM La Vista Middle School 2-5 $50 Tuesday, May 29-Friday, June 1 10:15AM-12:00PM La Vista Middle School 6-8 $50 Tuesday, May 29-Friday, June 1 1:00PM-3:00PM La Vista Middle School 9 $50
Wrestling Chris Curry ccurry@paplv.org Mon. July 23 - Thurs. July 26 6:30-8:00 PM PLHS Wrestling Room 3-8 $50 Mon. July 23 - Thurs. July 26 4:00-6:00 PM PLHS Wrestling Room 9-12 $50