2011 DSU Holiday QB & WR Academy

The Elite Quarterback & Wide Receiver Academy

Featuring QB Coach Joe Dickinson

Information Packet

Quinn Shanbour 2012 Top QB Prospect

Heritage Hall – Oklahoma City, OK

2010 National Prep Player of the Year and East Carolina University Quarterback, Cody Keith

Greetings from DeBartolo Sports University…

Renaissance Resort at World Golf Village and DeBartolo Sports University have teamed up for the 3rd DSU Holiday Quarterback and Wide Receiver Academy, recognized as the Nation’s premier development program.

From December 27, 2011 thru December 31, 2011, we invite you to be part of a first class, exclusive experience at one of Florida‟s finest retreats, Renaissance Resort at World Golf Village. Quarterbacks and wide receivers in grades 5th-12th will participate in a program that offers the opportunity to build upon their football foundation by training with experts that have had success developing athletes at all levels. DeBartolo Sports University’s notable quarterback academy alumni include: Josh Freeman (QB – Tampa Bay Buccaneers), Rhett Bomar (QB – Minnesota Vikings), Matt Barkley (QB – USC), and Dayne Crist (QB – Notre Dame).

Renowned quarterback coach, Joe Dickinson, will take participants through a simulated NFL and college camp complete with position specific skills training, speed, strength, and agility training, NFL film study and chalkboard sessions. Equally valuable to the training experience is the written, video, and photo coverage of the event. This exposure provides athletes a platform to further distinguish themselves in the recruiting world while also securing their position as a top football prospect. When not training, athletes have the opportunity to enjoy the luxury accommodations of the resort and participate in organized activities.

We invite you to take a closer look at the Elite Quarterback and Wide Receiver Academy and hope that you will consider joining us for what will be a memorable, rewarding and intense week of football.

Sincerely,

Donald Engstrom

Executive Director, DeBartolo Sports University



2012 Top 10 quarterback recuit, Josh Cousins

ELITE QUARTERBACK ACADEMY Program Overview

Summary: Through the years, athletes from across the globe have traveled to DeBartolo Sports University’s academy programs in search of the best training. In a tropical resort setting, high school and youth quarterbacks and wide receivers in grades 5th-12th will train and receive instruction on how to improve their technical, tactical, and mental abilities on the football field. Quarterbacks and wide receivers will receive approximately 18 hours of position specific instruction (12 hours on the field and 6 hours in the classroom). When:: Where: Check-in: Tuesday Dec 27, 2011 Renaissance Resort at World Golf Village Check-Out: Saturday, Dec 31, 2011 500 South Legacy Trail (There is no training on these days) St. Augustine, FL 32092 Cost: Quarterbacks: $1,495 Wide Receivers: $750 (During the online registration use discount code: HOLIDAYWR) This all-inclusive fee includes a four night stay at Renaissance Resort at World Golf Village, three meals daily with fruit and juice breaks, ground transportation to and from Jacksonville International Airport, Fitness Center access, DeBartolo Sports University performance apparel, and three days of skills instruction. Registration: All participants must pre-register for the event. Visit www.DeBartoloFootballAcademy.com and complete the online registration. A $300 deposit is required at the time of registration and final payment must be received by Friday December 9, 2011. Space is limited to the first thirty registered and paid athletes at each position. Participants will also need to complete the enclosed registration documents. Cancellation and Refund Policy: Only written cancellations received before December 9, 2011 are refundable, less a $75 handling charge. Cancellation after December 9, 2011 is not refundable but can be held as a credit for any DeBartolo Sports University program. Contact: If you have questions about the Elite Quarterback & Wide Receiver Academy please contact us at: Phone: 813.739.4091 SMS Text:: 657.200.1378 Fax: 813.676.2603 Email: [email protected] Web: www.DeBartoloFootballAcademy.com Facebook: www.facebook.com/DeBartoloSportsUniversity



http://www.debartolofootballacademy.com/





mailto:[email protected]








2011 Top 25 Pro-Style Quarterback and University of Arizona Commit, Daxx Garman

Coach Dickinson brings over 25 years of high school and collegiate coaching experience

exclusively to DeBartolo Sports University programs.

Recognized as one of the premier developers of quarterbacks in the nation, Coach Dickinson has

recently trained several of the nations top quarterbacks coming out of the high school ranks.

Quarterbacks including Matt Barkley (USC), Dayne Crist (Notre Dame), Terrelle Pryor (Ohio State), Jake

Heaps (BYU), Blake Bell(Oklahoma), and this years top quarterback recruits Cody Keith (National Prep

Player of the Year, East Carolina University Commit), Conner Preston (Southern Methodist University

Commit), and Daxx Garman (University of Arizona Commit) have all sought his training.

Under the guidance of Coach Dickinson, youth quarterbacks Augie DeBiase (Jacksonville,

Florida) and Grady Sullivan (Southlake Carroll, Texas) received National attention with their superior

play during the 2010 season and respective invitations to play in the Junior Rank Diamond Bowl and

the Eastbay Youth All-American Bowl.

In 2008 and 2009 Coach Dickinson helped current Minnesota Vikings QB Rhett Bomar prepare for the NFL Combine and pre-season camp.

Throughout this period he also worked with New Orleans Saints QB Chase Daniel, Tampa Bay Buccaneer first round draft choice QB Josh

Freeman, and Tampa Bay Bucs QB Rudy Carpenter.

Coach Dickinson served as the Offensive Coordinator and Recruiting Coordinator at several Division 1 football programs including: Tulsa (‟86-

‟89), Marshall (‟90), Northern Illinois (‟91-‟95), Oklahoma (‟83-85,„96-‟98), Tulane (‟99-‟00), and Central Oklahoma (‟03-‟06). The complete

offensive mastermind, Coach Dickinson‟s offenses routinely ranked at the top of the NCAA. Throughout his extensive career Dickinson had the

opportunity to coach alongside some of the best minds in football. He was on staff at Oklahoma University with Hall of Fame Coach and Super

Bowl Champion Barry Switzer when they won the 1985 National Championship. While at Marshall, he coached with the legendary Jim Donnan,

and during his time at Tulsa he coached with College Football Hall of Fame Coach John Cooper.

Early in his career at Oklahoma, Coach Dickinson worked with Pro Football Hall of Fame QB Troy Aikman. From there, he would go on to

recruit, coach, and mentor several 1st round draft picks including: JP Losman (QB, 2004/Round 1/Pick 32), Patrick Ramsey (QB, 2002/Round

1/Pick 32), Roy Williams (S, 2002/Round 1/Pick 8), and Stockar McDougle (OL, 2000/Round 1/Pick 20). From 1994-1997, four of Coach

Dickinson‟s running backs would have NFL careers: LeShon Johnson, James Allen, De‟mond Parker, and Jermaine Fezande.

Coach Dickinson mentored Heisman candidate LeShon Johnson at Northern Illinois during his nation leading rushing performance in 1993.

While at Tulsa, he produced NFL Quarterbacks T.J. Rubley and Gus Frerotte, who rank 1st and 2nd on the schools list of All-Time Passers

respectively.

In 2000, Joe Dickinson founded Fab50 Recruiting, a highly regarded scouting service for high school athletes. Today, Fab50 recruiting remains a

highly respected online scouting service.

Coach Dickinson has also appeared in the Snoop Dogg television series "Fatherhood," where he is shown tutoring Snoop Dogg's son who is

focused on developing his quarterback skills. He is also part of the up-coming documentary "The Hopeful" starring East Carolina recruit Cody

Keith. In 2011, Bright House Sports Network created a 1 hour television special focusing on Coach Dickinson and his training of young QBs.

Throughout his coaching career Coach Dickinson has had the opportunity to work and learn with some of the greatest minds to coach and play

the game including: Joe Avezanno, Rex Ryan, Jim Hanifan, Pat McPherson, Joe Jurasek, Terry Shea, Joe Montana, Randy Cross, Jon Embree,

John Blake, Bubby Brister, Jeff Weeks, Chris Scelfo, Barry Switzer, Jim Donnan, Bill Bates, and John Cooper.

Coach Dickinson currently resides in Choctaw, Oklahoma with his wife Teresa.



Quarterback Coach Joe Dickinson



The newest addition to the DSU family is Joe McCulley. Coach McCulley is a long-time coach and

administrator in the Oklahoma public school system and will be providing personal quarterback

instruction exclusively to DeBartolo Sports University. Not only does Coach McCulley bring to the table

a vast knowledge of the quarterback position ,but also a deep understanding of the game of football and

all aspects of what it takes to become a great player. Joe has 35 years of coaching experience: 29 years

as a head coach , 5 years assistant and offensive coordinator both in Oklahoma high schools and 1 year

assistant and quarterback coach at Southeastern Oklahoma State University.

Coach McCulley has coached 6 All-State quarterbacks, produced 25 all-state players, won 15 district

titles, had 11 state quarterfinals, 4 state semi-final appearances, and 1 State Championship. He has been

elected by his peers as an All State Coach and 12 times as District Coach of the Year.

Joe has worked with numerous college football camps including the University of Oklahoma, Oklahoma

State University, and the University of Tulsa. He had the opportunity to help establish the first team

camp in Oklahoma with long time University of Tulsa head coach and current University of Mississippi Offensive Coordinator David Rader.

As a player McCulley played quarterback for Anaheim High School in Southern California where he was mentored by former NFL coach Dick

Coury. After graduation he played quarterback at the University of Tulsa under the guidance of then offensive coordinator, former NFL coach

and player Jerry Rhome. During his tenure in 1973, he was the 2nd leading passer in the nation behind Jesse Freitas of San Diego State. He was

also ranked 2nd in total offense behind longtime Dallas Cowboy and Arizona State quarterback Danny White. While playing at Tulsa he had the

opportunity and good fortune to throw to elite receivers Drew Pearson (All –pro Dallas Cowboy), Steve Largent (Seattle Seahawks Hall of Famer),

and Raymond Rhodes (Pro-bowler and former Green Bay Packer‟s Head Coach).

Coach McCulley and his wife Sherry have 5 children and are currently living in Hennessey, Oklahoma where he is the Superintendent of schools.

Quarterback Coach Joe McCulley

Coach Ngu has brought her knowledge and expertise of Mixed Martial Arts to the DSU’s core training.

Ngu, who is a Black Belt in Okinawa style Karate has implemented the rapidly popular Mixed Martial

Arts (MMA) training regimen with specific specialization to kickboxing and muay thai. Her instruction

has been lent to DeBartolo Sports University since June 2010 and has attributed to the development of

over seventy-five clients.

Mixed Martial Arts (MMA) training has started to integrate its way to be a primary workout routine for

many football players across the country. From the entire Atlanta Falcons football team to individual

players such as linebacker Clay Matthews (Green Bay Packers) to quarterback Matt Leinart (Houston

Texans), MMA training has quickly gained a devoted following. "It has gotten me mentally

tougher,“ Leinart said. The quarterback also went on to say you develop an attitude that you can do

anything.

Accordingly, DSU has jumped on board with this progressive training and Ngu tailors the exercises to benefit position specific motions.

Paulette Ngu resides in Oklahoma City, Oklahoma with her husband.

Martial Arts Expert Paulette Ngu

Tuesday, December 27, 2011

4:00PM Athletes check into Renaissance Resort at World Golf Village

6:30PM Dinner

7:30PM Welcome Meeting

9:30PM Bed Check

11:00PM Lights Out

Wednesday, December 28, 2011 – Friday, December 30, 2011

7:30AM Wake-Up Call

8:30AM Breakfast Buffet

9:30AM Morning Session

-Film Study and Chalk Talk

-Speed, Strength, Agility, and Flexibility Training with Performance Specialists

12:30PM Lunch

2:30PM Afternoon Session

-On-Field technique training

6:00PM Dinner

7:15PM Evening Session

-Review of morning and afternoon practice

8:30PM Evening Activity

11:00PM Lights Out

Saturday, December 31, 2011

7:30AM Wake-Up Call

8:30AM Breakfast Buffet

12:00PM Resort Check-Out



Schedule of Events

Notable DSU Elite Quarterback Alumni



Youth Quarterback Alumni

Name Class School City State

Augie DeBiase 2016 Landrum Middle Ponte Vedra Beach Florida

Jack Diamond

Davis English

Gage Humphrey

Gavin Menichini 2014 Liberty Christian Southlake Texas

Carlton Potter 2018 Brandon Academy Brandon Florida

Caden Walters 2016 Dodge City Middle Dodge City Kansas

Mason Winter 2017 Dodge City Middle Dodge City Kansas

High School Quarterback Alumni

Name Class School City State

Travis Ball 2014 Southlake Carroll Southlake Texas

Jared Bassett 2014 Nease Saint Augustine Florida

David Cornwell 2013 Ponte Vedra Ponte Vedra Florida

Josh Cousins 2012 Liberty Christian Argyle Texas

Nick Duncan 2014 Springfield Catholic Springfield Missouri

Mac Katigan 2012 Casady Oklahoma City Oklahoma

Isaac Kay 2014 Houston Texas

TJ Menning 2012 Bishop Manogue Reno Nevada

John Perovich 2013 St. Marcellinus SS Mississauga Ontario (Canada)

Landon Root 2014 Kapaun Mt. Carmel Wichita Kansas

Quinn Shanbour 2012 Heritage Hall Oklahoma City Oklahoma

Sammy Silver 2014 Southlake Carroll Southlake Texas

Colby Simmons 2013 Gulf Shores Gulf Shores Alabama

Grady Sullivan 2015 Southlake Texas

Notable DSU Elite Quarterback Alumni



College Quarterback Alumni

Name School

Matt Barkley University of Southern Cal

Blake Bell University of Oklahoma

Richard Brehaut UCLA

Trevor Brown Brigham Young University

Brandon Connette Duke

Dayne Crist Notre Dame

Nelson Fishback Eastern Washington

Daxx Garman University of Arizona

Jake Heaps Brigham Young Univ

Austin Hinder Cal – Berkley

Cody Keith East Carolina University

Keaton Lewis Kansas State University

EJ Manual Florida State University

Paul Millard West Virginia

Nick Montana Washington

Nate Montana Montana

Josh Nunes Stanford

Ryan Polite UTSA

Conner Preston Southern Methodist Univ

Chase Rettig Boston College

Matt Scott University of Arizona

Russell Shepard Lousiana State University

NFL / Pro Quarterback Alumni

Name Team

Troy Aikman Dallas Cowboys

Todd Boeckman Jacksonville Jaguars

Rhett Bomar Minnesota Vikings

Rudy Carpenter Tampa Bay Buccaneers

Chase Daniel New Orleans Saints

Josh Freeman Tampa Bay Buccaneers

Gus Frerotte Washington Redskins

Jake Locker Tennessee Titans

JP Losman Buffalo Bills

Terrelle Pryor Oakand Raiders

Patrick Ramsey Minnesota Vikings

TJ Rubley LA Rams

Junior Rank All-American, Augie DeBiase

When should we arrive and depart? Athletes are encouraged to arrive in the early afternoon on Tuesday, and depart the following Saturday (checkout is at 12:00PM)

Will the Elite Quarterback & Wide Receiver Academy help get me recruited?

Yes. Through our extensive recaps and coverage of the event, your name will be known in the recruiting community. While you likely won't walk away from the program with a scholarship offer, it will at the very least give you some additional exposure and introduce you to programs that you previously may not have had access to. Who will my roommate be? All athletes are housed in guest suites. You may request a roommate if coming with a friend. Can my wide receiver come with me? Absolutely. Wide receivers will be treated to the same resort and training experience. This is a perfect opportunity to build chemistry with the person catching for you. What supervision is there for young athletes? Our youth campers are placed in a room with an Academy Advisor or in an adjacent room. Academy Advisors are on duty 24 hours. What if my parents are coming with? We strongly encourage your entire family to take part in the Academy experience. Please contact DeBartolo Sports University for special pricing on guests rooms and other amenities. What do we eat? All of the camper meals are prepared by the resort. If there are any food allergies or special request for kosher or vegan meals, please contact DeBartolo Sports University in advance. Will I need any spending money? Social activities may involve trips outside of the resort that may have extra fees. We advise bringing an additional $100 in the form of a prepaid Visa, Mastercard, or American Express Cards. Room charging is not allowed. What if I get into trouble? We take the responsibility of ensuring the safety of everyone very seriously, and we are very strict with enforcement of the rules and regulations. DeBartolo Sports University reserves the right to remove a child from camp and send them home without a refund. What should I bring with me? 10 pairs of socks, hats, shorts, and t-shirts for everyday workouts, casual clothes for evening activities, bathing suit, personal toiletries, prescribed medicines, sunscreen, and a cell phone or calling card. You will need your football, cleats, running shoes, notebook, and a writing utensil. Renaissance Resort and DeBartolo Sports University are not responsible for lost or stolen items. Please do not bring any unnecessary or expensive items. What is included in the participation fee? Simply put: everything. This is an all-inclusive experience once you arrive to the resort. It includes four nights stay at Renaissance Resort, three meals daily with fruit and juice breaks, ground transportation to and from Jacksonville International Airport, Fitness Center access, DSU performance apparel, and three days of skills instruction.

Frequently Asked Questions



Buccaneer QB Josh Freeman

About Renaissance Resort at World Golf Village

OVERVIEW Renaissance World Golf Village Resort and Convention Center is the premier vacation and meeting destination in the Southeast, offering groups, families, couples and friends a world full of Florida‟s finest pursuits. A golfer‟s paradise, this luxurious resort is set in the heart of World Golf Village… surrounded by two 18-hole championship courses designed by legends of the game…and central to St. Augustine, Jacksonville and beautiful Ponte Vedra Beach. The largest resort and conference center combination between Atlanta and Orlando, The Renaissance Resort offers a total of 86,000 square feet of meeting and event space. The resort sits on 6,300 beautifully landscaped acres, next to the one-and-only World Golf Hall of Fame, the Walk of Champions, PGA TOUR Golf Academy, PGA TOUR Stop retail center, and such restaurants as the golf-themed Murray Bros. Caddyshack. The 301-room Renaissance features a lush 10-story atrium garden lobby, complete with running streams, a cascading waterfall and exotic 30-foot palms. An all-new Colonial Asian theme and recent resort-wide renovations, apparent upon arrival, set the stage for an elegant, upscale stay, where your every need is our pleasure to handle. RECREATION The Renaissance Resort offers a wealth of recreational options that appeal to golfers and non-golfers alike. Discover two par-72 championship golf courses, the Hall of Fame‟s 18-hole championship putting course, and an Island Challenge Hole. Also enjoy a large heated pool, Jacuzzi hot tub, 24-hour fitness center and sauna, tennis courts, a handsomely decorated billiards room, and walking and jogging trails. In addition, the resort is next to the one-and-only World Golf Hall of Fame and IMAX® Theater, and guests have access to the PGA TOUR Golf Academy. A unique offering at the resort is Full Swing Golf, which is the world‟s finest indoor golf simulator. Superior technology and unmatched realism let you play, practice and learn on simulated greens of 22 top-ranked courses.



About DeBartolo Sports University

Edward DeBartolo Jr., five-time Super Bowl Championship owner of the San Francisco 49ers and two-time Stanley Cup Championship owner of the Pittsburgh Penguins, continues his vision of success through DeBartolo Sports University (DSU).

His 49ers teams were built with first class, Hall of Fame players such as Joe Montana, Jerry Rice, and Ronnie Lott, and visionary coaches such as Bill Walsh, George Seifert, and others. Regarded as the “players‟ owner”, Mr. DeBartolo‟s vision was to help athletes and coaches improve their skills, realize their talents, and maximize their potential through unparralleled development programs.

We aim to help athletes and coaches improve their skills, realize their talents and maximize their potential. DSU is a sports educational organization, dedicated to teaching, coaching, training and empowering student-athletes to achieve their potentials both on and off the field. DSU offers the highest quality events and training for athletes.

We believe that regardless of the sport an athlete chooses to focus on, a set of very similar training fundamentals are necessary to succeed in all sports. Whether it is football, lacrosse, baseball, or basketball, DSU will provide athletes and coaches with first class instructors and first class events. DSU specializes in sport specific and position specific training and all of our programs were created as first class training and development programs for amateur athletes.

The focus of DSU is to bring young talent to the forefront by offering developmental programs, designed to help amateur athletes and coaches reach their potential through coaching and mentoring from the pros. The training and development experts have not only played and coached at the highest professional level, but have trained some of the most successful professional athletes. With mentors like Joe Montana and Jerry Rice and coaches like Joe Dickinson, DSU offers athletes a once in lifetime opportunity.



2011 Top 25 Pro-Style Quarterback and Southern Methodist University QB, Conner Preston

What they have said…

"Coach Dickinson is one of the best in the business when it comes to teaching the mental and physical skills needed to play the Quarterback position at the highest level. His work with me leading up to the draft and training camp got me ready for the big jump from college to the NFL. I will continue to work with him my entire career.“

-Rhett Bomar (NFL Quarterback)

“The DeBartolo name means taking care of players and doing it right. This camp was no exception”

-Joe Pickert (Father of Quarterback Cole Pickert)

“This is where the best learn how to be the best, from the best. If this one week is any indication of how much my son will improve, I can not wait to watch him develop as a young man and as a quarterback.”

-Rick Purcell (Father of youth Quarterback Roman Purcell)

“DeBartolo Sports and Coach Dickinson made the Saddlebrook Camp one of the best ones Daxx has ever been to! Coach Dickinson, Coach Loyd, and Coach McCulley are about as good as it gets for QB’s.”

-Pat Garman (Father of Daxx Garman – University of Arizona QB)

“Nelson learned more about the quarterback position at this Academy than any other camp he's attended. Professional critiques from veterans with extensive experience at the D-1 and NFL level are what you'll receive at this academy. With a coaching staff consisting of ex-NFL players, a Heisman finalist and professional combine trainers, DeBartolo Sports University demonstrates a genuine commitment to helping young athletes improve their athletic skill sets and personal character traits.” -Greg Fishback (Father of Nelson Fishback – Eastern Washington University QB)



We are so thankful for what DeBartolo Sports has done, for the way Coach Dickinson has developed my son, from a character standpoint and an athletic standpoint, and without Coach Dickinson and DSU I don't believe Augie would be at the point he is today. I believe Augie has a great future and the only way we are going down that road is with Coach D by our side." - Mark DeBiase (Father of Quarterback Augie DeBiase)

Eastbay Youth All-American, Grady Sullivan

Registration Form

Athlete First Name:________________ Athlete Last Name: _______________

Home Address: __________________ Home Address (cont):______________

City: _________________________ State: ___________ Zip:__________

Home Phone:____________________ Athlete Cell:_____________________

Athlete Email:___________________ Parent Email: ___________________

Birthdate: ______/_______/_______ HS Graduation Year:_______________

School Name: ___________________ Apparel Size: Shirt ____ Shorts ______

Mothers Name: __________________ Fathers Name: __________________

Primary Position: _________________ Parent Cell: _____________________

How did you learn about our program: __________________________________

Do you have a specific roommate request:________________________________

What athletic Honors and Awards have you received: ________________________

________________________________________________________________________________________________________________________

What other achievements and awards have you received (Academic, Community, etc):

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Are you currently being recruited by College Programs, If so, who?:_______________

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Is there anything special that you feel we should know about you?________________

____________________________________________________________

____________________________________________________________________________________________________________________________________________________________________________________



Order Form



Description Cost Quantity Total

Quarterback Package - All Inclusive

$1,495 __________ $________ Includes 4 night stay at Renaissance Resort, training fees, meals, transportation to and from JAX airport, transportation to DSU events/practice, welcome package and apparel

Wide Receiver Package - All Inclusive

$750 __________ $________ Includes 4 night stay at Renaissance Resort, training fees, meals, transportation to and from JAX airport, transportation to DSU events/practice, welcome package and apparel

Quarterback Package - Less Hotel Room

$1,195 __________ $________ Created for those athletes that are local to the Jacksonville area or for athletes staying with their parents. This package includes 3 meals daily, transportation to and from JAX airport, transportation to DSU Events / practice, welcome package, and apparel

Wide Receiver Package - Less Hotel Room

$450 __________ $________ Created for those athletes that are local to the Jacksonville area or for athletes staying with their parents. This package includes 3 meals daily, transportation to and from JAX airport, transportation to DSU Events / practice, welcome package, and apparel

Parents Hotel Room Only

$660 __________ $________ Includes 4 night stay at Renaissance Resort in a private room with a king or 2 double beds and welcome package

Parent Participation Package (per person)

$395 __________ $________ Includes 3 meals daily, transportation to and from JAX Airport, transportation to and from DSU Events / practices, DSU apparel

Grand Total $

*Interested in attending but cannot participate each day, contact us for custom pricing

*Full payment is not due at time of booking, and we do allow payment over time. Contact us for more information.

PAYMENT FORM

BILLING INFORMATION

Name on Credit Card:

Credit Card Billing Address:

City / State / Zip:

Phone:

Email Address for Receipt:

CREDIT CARD INFORMATION

Visa Mastercard American Express Discover

Credit Card Number:

Credit Card Expiration: _____ / _____

I hereby authorize DeBartolo Sports and Events to process payment to my credit card in the amount of $__________.

Signature of Cardholder:______________________ Date: _____ / _____ / _____



Medical Payment Information

Athletes Name:__________________ Age: ______

Arrival Date: ___________________ Birthdate: _____ / _____ / _____

Insurance Provider: _____________________________

Policy Number:

_____________________________

Claims Address: _________________________________________________

Please provide copies of both sides of your insurance card

Phone Number: (____) ____________

Payment for medical services (circle one) Visa MC AMEX Discover

Card Numb: ________________________________Expiration Date: ________

Card Holder Name: _______________________________________________

Card Holder Signature: ____________________________________________

Transportation/Boarding Information All transportation is provided from/to Jacksonville International Airport.

Date of Arrival:___/___/____ Time:_______ Airline:___________ Flt #_____

Date of Departure:___/___/___ Time:______ Airline:___________ Flt #_____

Flight Confirmation Number – REQUIRED:_____________________________

City where flight originates/routing:___________________________________

Transportation details if not by air:____________________________________

Transportation from Jacksonville International Airport is provided non-stop by private shuttle service from 6:00am – 11:00pm. Additional charges apply if transportation is required outside the standard times. Only participants recognized by the airline as an “unaccompanied minor” can be met at the gate. A charge of $75 may be applied.

We recommend checking availability prior to booking airline flights!

The Elite Quarterback and Wide Receiver Academy


As a participant in the DeBartolo Sports University programs (“Event”), I acknowledge that participation in the Event exposes me to a possible risk of personal injury. I assume full responsibility for any and all such risk engaging in these activities, and DeBartolo Sports and Events, LLC dba DeBartolo Sports University, “Company”, its officers, directors, employees, agents, licensees, subsidiaries, consultants, independent contractors and affiliates shall not be liable for lawsuits, claims, or damages arising from any of these actions or activities regardless of fault or negligence of Company. I, hereby release the Company and its officers, directors, employees, agents, licensees, subsidiaries, consultants, independent contractors and affiliates, from any and all liability from property damage, personal injuries or other claims arising from or in connection with my participation in the Event including claims that are known and unknown, foreseen and unforeseen, future or contingent.

I covenant that I will not now or at any time in the future, directly or indirectly, commence or prosecute any action, suit or other proceeding against Company and its officers, directors, employees, agents, licensees, subsidiaries, consultants, independent contractors and affiliates, arising out of or relating to the actions, causes of action, claims and demands hereby waived, released or discharged by me.

I will defend, indemnify, and hold harmless Company , including and attorney‟s fees, from any lawsuits, claims or damages arising in connection with my actions or activities on or off of the Event premises, regardless of any fault of Company, or arising in connection with enforcement of the provisions of this agreement.

For good and adequate consideration, which I acknowledge I have received, I hereby grant, release, and quitclaim to Company royalty free the right and authority to use, sell, reproduce, and distribute, quoted material, biographical information, my photograph, likeness, contact information, recorded voice or videotaped filmed appearances (the "Materials") for promotional and advertising purposes or partner programs as Company in its sole discretion will deem appropriate. I acknowledge that I have read and fully understand this Injury Waiver and General Release Form. This agreement will be binding on me, my spouse, my children, legal representatives, heirs, successors and assigns. Company is the sole owner of all rights in an to the materials and shall have the sole right to broadcast such materials in whole or in part in perpetuity for any purpose in any medium. DATE: _______________________________________ PARTICIPANT PRINTED NAME: ________________________________________ PARTICIPANT SIGNATURE: ________________________________________ STREET ADDRESS: ________________________________________ CITY, STATE, ZIP ________________________________________ ----------------------------------------------------------------------------------------------------------------------------------------- PARENTAL CONSENT (To be filled out if participant is under the age of 18)

The undersigned ("Parent"), parent of ____________________________ ("Subject"), hereby consent to affirm, and, on behalf of Subject, agree to be bound by the Injury Waiver and General Release Form attached hereto which has been signed by Subject. Parents also represent, warrant and agree that Parents (is)(are) entitled to the care and custody of Subject and (is)(are) Subject's legal guardian(s); that during the minority of Subject and for a reasonable time afterwards, Parents will use all reasonable efforts to prevent Subject from attempting to or actually disaffirming the Injury Waiver and General Release Form signed by Subject; that Parents hereby acknowledge that Parents have read the Injury Waiver and General Release Form and are satisfied that it is fair and equitable for the benefit of Subject; and that Parents will not revoke this consent and approval.

DATE: ________________________ SIGNATURE: __________________________

NAME AND RELATIONSHIP TO SUBJECT: (please print)

NAME: ________________________ RELATIONSHIP: __________________________



Injury Waiver and General Release

Medical, Search & Recreational Release



I, the parent or guardian of ________________ by initialing the following items, acknowledge my consent and agreement that Renaissance Resort at World Golf Village and/or DeBartolo Sports and Events LLC dba DeBartolo Sports University is authorized to administer or consent on my behalf to administration of emergency medical care to my child(ren), and I certify that my child(ren) are fit and able to engage in rigorous physical training; to enter and to search my child(ren)‟s room and belongings for the presence of any contraband or dangerous instrument; to allow participation in and to transport my child(ren) out of Renaissance Resort World Golf Village for recreational activities including but not limited to , amusement parks, theaters, shopping centers, sporting attractions, etc.; My signature below indicates that on behalf of myself, my spouse, and my minor child(ren), I acknowledge and agree that;

a. My child(ren)‟s participation in rigorous, physical training, and transportation to and participation in said recreational activities can be dangerous and involve the risk of serious bodily injury;

b. I assume FULL RESPONSIBILITY FOR AND ALL SUCH RISK of my child(ren)‟s engaging in these activities, and DeBartolo Sports and Events LLC dba DeBartolo Sports University and its agents shall not be liable for any lawsuits, claims or damages arising from any of these actions or activities REGARDLESS OF FAULT OR NEGLIGENCE of DeBartolo Sports University, LLC;

c. I will defend, indemnify and hold harmless DeBartolo Sports and Events LLC dba DeBartolo Sports University, including attorney‟s fees, from any lawsuits, claims or damages arising in connection with my child(ren)‟s actions or activities on or off of the Renaissance premises, REGARDLESS OF ANY FAULT OF DeBartolo Sports and Events LLC dba DeBartolo Sports University, or arising in connection with enforcement of the provisions of this agreement.

Signature of Parent or Guardian:________________________Date:_________

Family Physician:_______________________ Phone #: (_____)___________

Please include special instructions on a separate sheet (medications, allergies, injuries)

Contact Us

For more information or to register, please contact:

DeBartolo Sports University

15436 N Florida Avenue, Suite 200

Tampa, FL 33613

PH: 813.739.4091

FAX: 813.676.2603

Email: [email protected]

www.DeBartoloFootballAcademy.com

www.facebook.com/DeBartoloSportsUniversity

www.twitter.com/DeBartoloSportU

Renaissance Resort at World Golf Village is located at:

500 South Legacy Trail

St. Augustine, Florida 32092



http://www.debartolosportsu.com/

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2011 DSU Holiday QB & WR Academy

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