purdue calumet - Merrillville Community School

Purdue University Calumet Medical Authorization
for Treatment of a Minor (persons under 18 years)
PURDUE CALUMET
Pursuant to Indiana Code Paragraph 16-36-1-6, I request and authorize
Hammond Fire/Ambulance, St. Margaret Hospital medical personnel,
agents, and employees to provide all reasonably necessary medical
care advisable for the health of my child, including but not limited to
medical transport, hospital tests, such a pathology, radiology, anesthesia, evaluation and treatment by physicians, including surgery, and
prescription drugs. I acknowledge that no representations, warranties, or guarantees can be made with respect to any medical care of
treatment provided. I also understand that, as a result of my child’s
participation in this program, it will be necessary for supervisors,
coaches, counselors, and others involved with the program to have
access to relevant medical information pertaining to my child, and I
authorize the use and disclosure of my child’s medical information to
promote a safe and healthy experience for my child.
Julie Wiejak became the sixth head volleyball coach in Purdue Calumet
history beginning with the 2014-15 season.
Further, I hereby grant permission for my child to attend
the 2015 Purdue University Calumet Summer Camp by
signing below. A signature from one or both parents
/ legal guardians and a witness is required.
HEAD COACH JULIE WIEJAK
Wiejak comes to Purdue Calumet from Andrean High School where she
spent the past three years at the helm of the girl’s volleyball program.
She compiled an impressive 85-22 record, while leading the 59ers to the
first two IHSAA Semi-State appearances in program history. At Andrean,
she coached seven all-conference selections, five all-area honorees and
one NWI Times All-Area Player of the Year in Ana Nicksic. Wiejak also
served as the head coach of the St. Patrick’s (Ill.) boy’s volleyball coach
the past two seasons, leading the team within a game of the state tournament in 2012 and 2013.
In addition to her high school coaching duties, Wiejak is active in the club
volleyball ranks. She is in her third year as the director of the Southshore
Volleyball Club, while also serving the director of coaching development
and fundraising for Powerhouse Sports Academy, the parent organization
of SSVBC as well as Powerhouse VBC, Club 1 VBC, and Hardcross VBC.
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Prior to her time at Andrean, Wiejak served as the top assistant at her
alma mater, Loyola, for four seasons, where she worked primarily with
the Ramblers’ middle blockers. During her time on the Loyola bench,
Wiejak’s teaching was proven to be instrumental in the development of
several record-setting Loyola middles. Under her watch, Mallory Curran
broke the school’s career record for block assists, becoming the first
Loyola player to break the 300-block assist plateau. Melissa Craig also
set new school records during Wiejak’s tenure, eclipsing the top marks
for blocks in a match and block assists in a season.
Her coaching experience also includes a six-year stint as an assistant
coach at DePaul. While in Lincoln Park, she involved with all aspects of
the Blue Demons’ program, helping guide the program to its first NCAA
Tournament appearance in 2001.
Signautre Parent/Legal Guardian
Signautre Parent/Legal Guardian
Witness
She was also the director of the Great Lakes Region High Performance
Program, an extension of the governing body of USA Volleyball, coordinating camps and competitions while also handling the business and
financial aspects of the program for the seven years it existed. In 2005,
for her efforts within the USA Volleyball community, Wiejak was given
the Robert L. Lindsay Meritorious Service Award, which recognizes individuals for contributing outstanding participation, motivation, and other
services in the promotion of volleyball.
A member of the Positive Coaching Alliance, Wiejak was named one of
organization’s the Top 50 Double Goal coaches in the nation. She was
also nominated for Indiana’s 2011 AVCA National High School Coach of
the Year, while being selected to the “Top 20 under the age of 40” class
of 2012 by Northwest Indiana Times Business Magazine.
2015 VOLLEYBALL CAMP
LOCATION
Purdue University Calumet
Fitness & Recreation Center
2300 173rd Street
Hammond, IN 46323
DAY CAMP
July 6-9, 2015
TIME
9:00 AM - 11:00 AM | Grades K-4
11:30 AM - 2:00 PM | Grades 5-8
COST
$100 - Grades K-4
$120 - Grades 5-8
OVERNIGHT CAMP
July 20-23, 2015 | Grades 7-12
COST
$350 - Overnight Camper
$250 - Commuter Camper (with meals)
$200 - Commuter Camper (without meals)
DAY CAMP
The camp will focus on individual and team skills; specifically
court- related movement, non-court related movement, hand-eye
development with the ball, body movement and ball work, footwork, agility and an introduction to the sport of volleyball. All
skills will be covered; passing, setting, hitting, defense, blocking,
along with position specific training. The emphasis at the camp is
fun while learning the sport of volleyball!
ELITE OVERNIGHT CAMP
The overnight campers will arrive at the FNRC on July 20, where
they will check in and participate in two sessions that day. On July
21-22 there will be three sessions, followed by one final session
and check out on July 23. The camp will focus on high level skill
training and try-out preparation. Over 22 hours of volleyball instruction packed into 3 fun-filled days! Get a feel for the college life
by staying in the dorms. The Purdue Calumet team will be instructors the entire camp and will also stay in the dorms and interact
with the campers! Roommate requests will be taken below.
Roommate Request: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - CUT HERE - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PURDUE CALUMET
PURDUE CALUMET
VOLLEYBALL CAMP REGISTRATION
Camper’s Name
SUMMER DAY CAMP (July 6-9)
 Grades K-4 (9:00 AM - 11:00 AM) - $100
 Grades 5-8 (11:30 AM - 2:00 PM) - $120
SUMMER OVERNIGHT CAMP (July 20-23)
 Commuter Camper (without meals) - $200
Address
 Commuter Camper (with meals) - $250
 Overnight Camper - $350
City
StateZip
(Overnight camp is for grades 7-12)
*Sign up before May 15th to save $25 on the
Phone
Overnight Camp!
PAYMENT INFORMATION
Email
Make all checks payable to Purdue Calumet Athletics
Graduation Year
Age
MASTERCARD
VISA
DISCOVER
Primary Position
Secondary Position
CREDIT CARD NUMBER
High School
Travel Team
First Emergency Contact Name
EXPIRATION DATE
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Cell Phone
Day Phone
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Night Phone
Relationship to Participant
Second Emergency Contact Name
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Cell Phone
TOTAL PAYMENT
CARDHOLDER NAME
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Day Phone
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Night Phone
Relationship to Participant
CONTACT
• Please contact Head Coach Julie Wiejak at (219) 989-2540 or
Julie.Wiejak@purduecal.edu with any questions.
SIGNATURE
Mail Completed Form to:
Julie Wiejak
Intercollegiate Athletics
Purdue University Calumet
2200 169th Street
Hammond, IN 46323
Online registration coming soon at
http://www.purduecalsports.com/fanzone/camps/