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									       INDIVIDUAL CAMP REGISTRATION                                         TEAM CAMP REGISTRATION




                                                                                                                                      MaChelle Joseph Basketball Camp
        www.machellejosephbasketballcamp.com                                   Saturday, June 12, 2010




                                                                                                                                          150 Bobby Dodd Way
Name__________________________________                                    Team Name_______________________________




                                                                                                                                           Atlanta, GA 30332
Address_________________________________                                  Coach’s Name_____________________________
City____________________ State____ Zip______                              Team Address______________________________
Email (used for confirmation)                                             City________________State_____ Zip_________
__________________________________________
                                                                          Email (used for confirmation)
Phone____________________________________
Birthday __/__/_____ Age___
                                                                          _______________________________________
                                                                          Work Phone______________________________
                                                                                                                                                                                 2010
Grade (in fall) __ School_______________________                          Cell Phone_______________________________
                                                                                                                                                                         MaChelle Joseph
                                                                                                                                                                            Basketball Camp
Years Experience___ Position __________________                           Number of players attending _______________
                                                                          (Complete roster must be submitted by June 1, 2009)
T-Shirt Size: YM             YL      AS     AM       AL      AXL
                                                                          Competitive Level:      Varsity     JV      Middle School
Roommate Preference _______________________                               (AAU please select level)
I give my daughter permission to attend:
                                                                          Team 2 Name_______________________________
X_______________________________________
                                                                          Coach’s Name_____________________________
CHOOSE A CAMP (Circle the camp(s) you want to attend)                     Team Address______________________________
Camp          Dates                         Cost
High Intensity Camp       June 18-19               $100 overnight         City________________State_____ Zip_________
                                                   $60 commuter           Email (used for confirmation)
Individual Day I         June 21-24                        $250           _______________________________________
Individual Day II        July 5-8                        $250             Work Phone______________________________
Overnight Camp          July 28-31                 $385 overnight
                                                                          Cell Phone_______________________________
                                                   $310 commuter
Elite Day Camp          August 21                           $25           Number of players attending _______________
                                                                          (Complete roster must be submitted by June 1, 2009)
DISCOUNTS $10 sibling discount / $20 discount groups of 5+
PAYMENT Our camps require a 50% deposit with registration.
Payments accepted are Visa, Master card, check, money order, or cash.     Competitive Level:      Varsity     JV      Middle School
Refunds will only be issued if cancellation is made 7 days prior to the   (AAU please select level)
beginning of each camp. $25.00 administrative fee applies. We also
require a completed medical insurance information form, copy of           *Please submit deposit with registration
insurance card (or purchase $10 camp insurance), and a recent
physical / physician’s release. It is against NCAA regulations to give
discounts or waive any fees. ** $150 deposit for team camp **                        MaChelle Joseph Basketball Camp
Application may be faxed to 404-385-7315.                                              150 Bobby Dodd Way, NW
                                                                                          Atlanta, GA 30332
Credit Card Authorization                                                                     404-894-4297
Name on Card___________________________________                                        JBlanchard@at.gtaa.gatech.edu
                                                                                                        OR
CC # __________________________________________                                              Register on-line at:
                                                                                www.machellejosephbasketballcamp.com
VISA / MASTERCARD               Expiration Date ___________

Signature
__________________________________________
Send checks with application to:
MJ Specialty Camps                                                                                                                                                       Learn From The Very Best!
150 Bobby Dodd Way, NW
Atlanta, GA 30332                                                                                                                                                       A GREAT CAMP EXPERIENCE
                                                           INDIVIDUAL DAY CAMP I / II
MaChelle Joseph is in her seventh season                             $250
as head coach of the Yellow Jackets. Prior to   This basic skills camp is designed to teach the
                                                fundamentals of basketball to beginning level players.
taking on that role she was an assistant at     Girls ages 6-15 are encouraged to participate in this fun
Georgia Tech for two years, during which        and energetic four day camp. This camp focuses on the                MaChelle Joseph
time she signed two of the top recruiting       fundamentals of basketball through station work and
classes in Tech women’s basketball history.
                                                competition. Areas of emphasis include shooting,
                                                fundamentals, ball handling, individual offense and
                                                                                                                    High Intensity Camp
Joseph has played and coached at the            individual defense. Campers are divided by age and skill
                                                level to ensure the best experience for each camper.                        $100 Overnight
highest level for over 15 years. She was a      - 1 on 1 coaching from Yellow Jacket Players & Staff                         $60 Commute
Kodak All-American as a player at Purdue        - Free Camp T-Shirt
and has tremendous coaching experiences         - Free Camp Ball                                                The MaChelle Joseph High Intensity
under legends Lin Dunn and Joe Ciampi           Start Time: 9:00 AM                                             Camp is a day or overnight camp that
                                                End Time: 4:00 PM                                               is designed to enhance the skills of
as an assistant at Purdue and Auburn            DAY I                                JUNE 21-24
Universities. Joseph is now prepped to                                                                          advanced players. The coaching staff
                                                DAY II                                JULY 5-8
                                                                                                                will train the athletes with collegiate     Team Camp / Shootout
make her mark at Georgia Tech. She would                                                                        level drills and technical feedback.
like to welcome you to join her and her staff                                                                   The High Intensity Camp is for
                                                                 OVERNIGHT CAMP                                                                                          $250 Team
for a great summer of basketball                                   $385 overnight                               advanced players preparing for the
fundamentals and competition camp this                              $310 commute                                next level. Intense, individualized
                                                Girls ages 9-17 are encouraged to participate in this fun and   instruction from college coaches and      The Team Shootout is a one day event
summer!                                                                                                                                                   that offers AAU, Middle School, and
                                                energetic overnight camp. This camp focuses on the              players in the player's preferred
                                                fundamentals of basketball through station work and
                                                                                                                position is given. Athletes grade 8-12    JV and Varsity High School teams the
                                                competition. Areas of emphasis include shooting,
Go Jackets!                                     fundamentals, ball handling, individual offense and             are encouraged to attend. There are a     opportunity to develop team
                                                individual defense. Campers are divided by age and skill        limited number of spaces available.       chemistry and performance through
                                                level to ensure the best experience for each camper.
                                                                                                                The 2 day/ 1 night camp is open to        competition. Each team will be
                                                - All meals are included
                                                                                                                day campers as well.                      guaranteed a minimum of 3 games in
                                                - Free Camp T-Shirt                                                                                       the shootout. Teams are limited to 15
                                                - Free Camp Ball
                                                                                                                - Individualized coaching from Yellow     players. High School rules will be
                                                Check in: 6:00 PM on July 28                                      Jacket Players & Staff                  followed. Teams are divided based on
                                                Check out: 12:00 noon on July 31                                                                          coach’s choice of competitive level.
MaChelle Joseph                                 Start Time: 9:00 AM                                             - Free Camp T-Shirt                       This is a great summer experience to
Head Coach                                      End Time: 9:00 PM
                                                                                                                - All meals included                      take your team to the next level
                                                OVERNIGHT                                 JULY 28-31                                                      competitively.    There are a limited
                                                                                                                Check – in: 11:00 a.m. on June 18         number of spaces available so be sure
                                                                                                                                                          to send in your team deposit early.
                                                                   ELITE DAY CAMP                               Check-out: 5:00 p.m. on June 19
                                                                         $25
                                                                                                                                                          - Free Camp T-Shirt
                                                The Elite Day Camp is a one day camp designed to enhance
                                                the skills of advanced players. Intense, individualized               JUNE 18-19, 2010                    - Games run all day – 9:00 AM – 9:00 PM
                                                instruction from college coaches and players in the player's
                                                preferred position is given. Athletes in grade 8-12 are
                                                encouraged to attend.
                                                Start Time: 9:00 AM
                                                End Time: 1:00 PM
                                                ELITE DAY CAMP                              AUGUST 21
                                                                                                                                                                   JUNE 12, 2010
       MACHELLE joseph basketball CAMP
                             Medical Release Form

                             R E G I S T R A T I O N WILL NOT B E C O M P L E T E
                        UNTIL THIS RELEASE FORM IS SIGNED AND RETURNED

Since most of the campers attending our camp are under 18 years of age, it is necessary that our doctors have
parents’ permission to administer treatment in the event of accident or sudden illness. (If you are 18, this form
requires your signature.)

Name:
                Last                             First                             Middle

Any Allergies to Medication:              If so, Please List:


Please List Any Conditions Physicians Should Be Aware of:



EMERGENCY PHONE NUMBERS
Person to Notify:                                                  Relationship:
Daytime Number:                                            Evening Number:



I hereby authorize any medical treatment, which may be advised or recommended by the camp trainers or attending
physician of                            while attending the MaChelle Joseph Basketball Camp.
                 PARTICIPANT’S NAME


                  ALL participants require INSURANCE COVERAGE for accidental injury.
                          PLEASE INDICATE YOUR CURRENT INSURANCE DATA BELOW
           I have the required insurance


         Insurance Company

         Policy Number

         Parent or Guardian Signature                                                        Date



Release and Waiver of Liability (Please read carefully before signing)
I                          (parent/guardian name) understand that an injury may result from participation in camp
related activities. I hereby release the MaChelle Joseph Basketball Camp, MJ Specialty Camps, the coaching staff
and trainers, the Georgia Tech Athletic Association and the Georgia Institute of Technology from any and all liability,
claims, demands, action and causes of action whatsoever arising out of or related to any loss, damage, or injury,
including death, that may be sustained by my child while participating in such camp related activities, or while in, on,
or upon the premises where the activity is being conducted. As the parent/guardian of the above listed camper, I also
give permission for any emergency medical care or treatment that may be required, including transportation and
accept responsibility for the costs.
SIGNATURE
PARENT OR GUARDIAN:                                                                         DATE:

								
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