Camp Information
NORTHERN STATE UNIVERSITY
This is a non-padded football camp
designed to provide detailed instruction in
the fundamentals of Offense, Defense and
Special Teams.
The camp is for anyone entering the
grades of 4-8.
Camp Fees & Registration
Early Registration
$40
Day of Registration
$50
May 20 & 21, 2014
(5:00 to 6:00pm at Swisher Field)
Fee for camper’s registration covers instruction,
NSU season game pass and camp T-shirt.
For More Information
please contact:
Coach Mark Martin
(605)626-3979
Email:
[email protected]
from
6:00 to 8:00pm
@
Swisher Field
CAMP STAFF
TOM DOSCH HEAD COACH
Tom Dosch, a veteran of
22 years in collegiate
coaching, is entering his 5th
year as Northern State’s
Head
Football
Coach.
Coach Dosch and the
Wolves have won 15 games
over the last 3 years.
Prior to his hiring, Dosch had spent the two
seasons at Southern Illinois University, overseeing
the inside linebackers and special teams for the
Salukis, who won the Missouri Valley Conference
title both years. SIU qualified for the NCAA Division
I-Football Championship Sub-Division (FCS)
playoffs in both 2008 and 2009, finishing the 2008
season ranked eighth in the nation. The Salukis
were also ranked No. 1 in two national polls at the
conclusion of the 2009 season.
Prior to his time at SIU, he compiled a 25-17 record
in four seasons as the head coach at Jamestown
College. Under his direction, the Jimmies qualified
for the NAIA playoffs twice and were ranked as high
as sixth in the nation in 2007. He also coached
players to 14 All-America honors and 18 Academic
All-American accolades in those four seasons.
MARK MARTIN Assistant Coach
MATT MCLAGAN Assistant Coach
JASON HOSKINS Assistant Coach
MAIA TUPOU Assistant Coach
MATT RACOWSCHI Assistant Coach
BRANDON GORSUCH Assistant Coach
SHANE CLANCY Assistant Coach
ADAM KEIFER Assistant Coach
Enrollment Form
Please print and fill out both sides of this form. Please use a
separate form for each camper.
Camper’s Name______________________________________
Address____________________________________________
___________________________________________________
City/State/Zip________________________________________
NSU Athletics Consent
For Participation and
Medical Information
Campers Name_____________________________________________
In case of emergency, contact_________________________________
Emergency contact phone #___________________________________
Medical Insurance Co._______________________________________
School_____________________________________________
Policy #________________________________ Group #_____________
Parent or Guardian____________________________________
Physician name______________________ Phone_________________
Home Phone_________________________________________
Hospital preference:__________________________________________
Work Phone_________________________________________
Medical conditions the youth program staff and medical emergency
services personnel need to be made aware of:
Cell Phone_________________________________________
_____________________________________________________
E-mail Address_______________________________________
Age___________________ Grade next year_______________
T-Shirt Size (circle one): Youth
Adult
M
L
S
M
L
XL
Payment Amount Enclosed______________________________
Make Checks Payable to NSU FOOTBALL
Send application & payment to:
Northern State University
Attn. Football/Coach Martin
1200 S. Jay St.–Aberdeen, SD 57401
Make checks payable to NSU Football
Phone: 605-626-3979
I wish to register my minor child named above and consent to my child’s
participation in the summer sports camps and leagues sponsored by the
Department of Intercollegiate Athletics at Northern State University during
the summer of 2014.
I recognize that participation in recreational and instructional activities,
even when well supervised and managed, poses a risk of physical injury
to my child, and I agree to assume such a risk on behalf of my child.
I understand that children registered for NSU Athletics summer sports
camps and/or leagues will receive instruction in the basic principles of the
sport of their choice and will spend a significant amount of time practicing
and performing sporting techniques and/or researching and performing a
variety of enrichment techniques under the supervision of experienced
instructors, and I consent to my child’s participation in this program.
I consent to the transporting of my child in University vehicles to and from
various locations on campus and in the Aberdeen area for recreational
and instructional activities.
I consent to the use of video recordings and photographs of my child’s
participation in NSU Athletics summer sports camps and league
programs.
I certify that my child has no medical condition or impairment, including
the use of medication, which might inhibit his participation.
RELEASE OF LIABILITY
I, the undersigned, hereby hold the Regents of Northern State University
harmless from liability for any and all medical and/or accident expenses
which my minor child may incur during his/her involvement in the summer
sports camps and/or leagues at the Department of Intercollegiate
Athletics, Northern State University. I hereby certify that my child is
provided coverage via personal health and accident insurance in affect
which is sufficient to cover any and all of the expenses, noted above
which might occur.
Parent/Guardian Signature_____________________________________
Print Parent/Guardian Name___________________________________