Girls Basketball Application - EMW Boys and Girls Club

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					2011 GIRLS BASKETBALL
  SUMMER DAY CAMP

WAIVER OF LIABILITY
I hereby desire that my child, who is entering
grades 8 & younger, participate in the
Basketball Summer Day Camp sponsored by
the Boys & Girls Club of Elma, Marilla and
Wales. By condition of this release, I
acknowledge and agree that all the
requirements, directions, supervision and
standards set by the directors of this program
should be established for his/her benefit. I
hereby voluntarily assume all risk of accident
or injury to my child which may arise out of his
participation in this program, hereby intending
to release The Boys & Girls Club of EMW,            2011 GIRLS BASKETBALL
Tracey Karp, Iroquois Central School and all
personnel associated with this basketball
                                                      SUMMER DAY CAMP
camp from liability that may result from his/her       Entering grades 2-8
participation. As a condition of participation in
the Boys & Girls Club Basketball Camp, each                 July 25-29
participant must have a physical check-up by a         9:30 a.m. - 4:30 p.m.
certified physician within the last calendar
year.




Signature of Parent/Guardian
_________________________                                OF ELMA, MARILLA, WALES
Date of Last Physical
_________________________                                2080 Girdle Rd.
Please list any physical/medical conditions that          Elma, NY 14059
we should be aware of                                        652-9292
_____________________________                            www.emwclub.org
_____________________________
                                                                                                                     REGISTRATION FORM FOR 2011
  2011 Girls Basketball                                               WHAT TO EXPECT                                         GIRLS BASKETBALL
       SUMMER DAY CAMP                                                                                                       SUMMER DAY CAMP
                                                       Fundamentals: Individual and Team; Grouped by
                                                                                                                                 fill out front & back
                                                       age and ability:
                                                       2nd-4th grade, 5th & 6th grade                             Name:______________________________
                                                       7th & 8th grade                                            Address:___________________________
                                                       Small team sizes; One game per day                         City:____________________Zip:________
                                                       Friday: Championship Game; Awards                          Phone:_________________________

    WHO SHOULD ATTEND?
                                                                                                                  Age:_____School:____________________
                                                       Parents are welcome to join us for Championship
                                                                                                                  D.O.B._____________Entering Grade:______
                                                       Game and Awards.                                           E-Mail: _____________________________
  Girls entering grades 2-8 who wish to learn
fundamental skills and enhance playing ability         FREE CAMP T-SHIRT                                          T-Shirt Size (Adult):
                                                                                                                     S___ M___ L____ XL____ XXL____
           of the game of basketball.
                                                               TYPICAL CAMP DAY
             WHEN IS IT?                                                                                                  $100 - Check Enclosed
                                                                                                                        Payable to EMW Boys & Girls
      July 25-29, 9:30 a.m. - 4:30 p.m.               Group warm-up drills
                                                      Station work - Fundamentals
            WHERE IS IT?                              Lunch (Bring your own)
                                                                                                                    PAYMENT/REFUND POLICY
The Girls’s session will be held at the Boys &        Individual Competitions                               • Payment must accompany application
                                                      Guest Speakers                                        • Your spot is not secured until payment and
  Girls Club of Elma, Marilla, Wales, 2080
                                                      Games                                                   application are received.
            Girdle Rd., Elma, NY                                                                             • Refunds will be issued on cancellations
                                                      Dismissal                                                received at least two weeks prior to camp.
      WHAT IS THE COST?                                                                                         NO REFUNDS after two weeks prior to camp
                                                                                                                unless spot can be filled by waiting list.
                                                            CAMP DIRECTORS
         The cost for this one-week,
                                                                                                                ABSOLUTELY NO REFUNDS after camp starts
     half-day camp is $100 per camper.
                                                                  JASON THEAL                                       MEDICAL AUTHORIZATION
                                                            Boys & Girls Club of EMW
                                                                  Program Director                         Physician’s Name:____________________
    *We need a MINIMUM of 20 campers per              Boys and Girls Club 5th-8th Grade Coach              Phone No.__________________________
          Club to run baseball camp.                       Boys Basketball IAABO Official                  In an emergency, I hereby give permission for my
                                                                                                           child to be examined by the camp’s certified (first aid and
                                                                       STAFF                               CPR) staff. I also give permission to the licensed
              AWARDS                                 Area High School Varsity and JV Players               physician, selected by the camp operator, to hospitalize,
             Camper of the Day                   Coaches will assist with instruction, game coaching and   secure proper treatment, anesthesia or surgery for my
             3 on 3 Champions                                          refereeing.                         child in an emergency. I also give the camp permission to
               Spot Champion                                                                               advise the hospital of our health insurance at the time of
             League Champions                                                                              any treatment. Our health insurance is covered by:
              1 on 1 Champions                                                                             _________________________________________
             Lay –Up Champion
               Coaches Award
                                                                                                             Contract or Group No.
ssion to

				
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posted:7/13/2011
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