2010 Pure Sky Vault Camp
Pure Sky Vault will be holding camp in February. The camp will on the 20th , 21st
Cost is $120 per Participant Deposit $50 due Feb.
12th Late fee $20
FREE for Coaches!!
Make check out to Robert Tilley
Send Information sheet, check and Pole Vault waiver (if applicable) to:
Robert Tilley
Pure Sky Vaulting
303 N. Racetrack Rd.
Henderson, NV 89015
Camp Schedule
Saturday, Feb. 20 Sunday, Feb. 21
Check in is from 7:30 – 8:00 AM Coaches meet from 8:00 – 9:00AM
Camp will run from 8:00 – 4:00 PM Camp will run from 9:00 – 3:00PM
(1 Hr. Lunch Break on your own) (1 Hr. Lunch Break on your own)
* Intro of Coaches * Review of Sat. material
* Rules of camp * Running Form
* Safety * Approach
* Approaches * Vault/jump Drills
* Gymnastics * Full run vaulting
* Plyometrics * Full approach jumps
* Season training * Video
Things to bring to camp:
* Pole * Notebook with pen * Money for snacks
* Sweats * Towel * Tape
Directions to Camp:
**** Any questions, please contact Robert Tilley at 702-565-7547
Printer Friendly Registration Form
Registration Form:
This form must be completed and submitted with payment before you will be allowed to participate.
Name: ______________________________________________________________________________
Male: _____ Female: _____ T-Shirt Size: S M L XL
Camp Dates: Feb. 20 & 21, 2010
Email address: __________________________________________________________
Home Address: __________________________________________________________
City/State: __________________________________________________________
Zip: __________________
Parents’ Name: __________________________________________________________
Home Phone: __________________________________________________________
Athlete’s Cell Phone: __________________________________________________________
Emergency Phone and Contact Person: _____________________________________________________
Age: _______ Date of Birth: __________________________
HS Graduation Year: __________________
School Name: __________________________________________________________________________
School Coach: _________________________________________________________________________
What is your PR (personal record): ______________
Informed Consent and Release
I hereby grant permission for myself / child to attend Pure Sky Vault Club or camps. I verify that I / my child has had a physical exam in the past year and is capable to participate in the activities related to pole vaulting. I agree to indemnify, hold harmless, and defend all coaches and staff of Pure Sky Athletics, USA Track and Field, Pure Sky Athletics, their agents, employees and sponsors from any and all liability for injury to myself and/or my child. I understand that track and field, and in particular pole vaulting and many of its related activities are potentially dangerous and could pose risk of injury. Should medical attention be necessary, I hereby authorize any physician or trainer selected by the club personnel to conduct medical or surgical procedures. In addition, I hereby grant permission for Pure Sky Athletics to use any photographs or videotape of club related activities for the purpose of advertising or educational materials development. I HAVE READ AND UNDERSTOOD, AND AGREE WITH THE INFORMED CONSENT AND RELEASE OUTLINED AS IT RELATES TO MYSELF/SON/DAUGHTER.
Parent / Guardian Signature: ______________________________________________________