Name _________________________________ Address _________________________________ City ________________________ State _____ Zip_________ Age _____ Height _______ Weight ______ DOB _____________________ Home Phone:_________________________ Parent/Guardian Phone ___________________ Parent Name(s) ____________________________ School__________________________________ Grade (Fall 2012) ______ Coach ______________________ T-Shirt Size (circle): S
*** LUNCH IS INCLUDED. PLEASE PROVIDE YOUR CHILD W/ CANTEEN MONEY, AS SNACKS, DRINKS, AND CANDY WILL BE FOR SALE Please check all that apply: Week 1 - June 25—29 — $200 Week 2 - July 30—August 3 — $200
Centenary College named Justin Phoenix it’s head women’s basketball coach on September 1, 2011. Phoenix comes to Centenary after spending three seasons at Kean University, where he was an assistant for the women’s basketball team. During his tenure at KU, the team went 75-15 with one New Jersey Athletic Conference (NJAC) Championship, three NCAA Tournament appearances and two Sweet Sixteen runs. He helped develop three AllAmericans, two NJAC Players of the Year, one NJAC Defensive Player of the Year and one player playing Professional Basketball in Puerto Rico.
Both Camps — $350 Early Registration: (Deadline - April 24th) — $180 Group Discount: (8 or more: Deadline - April 30th) $175
Phone:: 908-852-1400 ext. 2194 E-mail: email@example.com
Only ONE discount can be applied to a camper or group of campers. (*Discounts may not apply for students entering grades 9-12)
2012 Girls Basketball Day Camp Entering Grades 4-12
Personal Checks and cash will only be accepted at registration for the remaining balance. Enclosed is my check for ___________ (full payment) Enclosed is my check for $100 (*non-refundable deposit to ensure my daughter’s enrollment in the camp) *Non-refundable deposit is $100 per week of camp attended
Week 1: June 25 - June 29
Please make checks payable to: Centenary College Please detach application and mail with check to: Centenary College Women’s Basketball Camp 400 Jefferson Street Hackettstown, NJ 07840
Chelsea Wolf Assistant Coach Co-Camp Director
Erin Geary Assistant Coach Co-Camp Director
Week 2: July 30 - August 3
MEDICAL RELEASE FORM
Centenary Women’s Basketball Day Camp WEEK 1 Mon - Fri - June 25 - June 29 9:00 am - 4:00 pm - $200 WEEK 2 Mon - Fri - July 30 - August 3 9:00 am - 4:00 pm - $200
Lunch is included. Please provide your child with canteen money as snacks, soda and candy will be for sale.
INDIVIDUAL SKILL SESSIONS Want to improve your game? Individual skills sessions will be available after camp every day except on Fridays. One of the camp directors will be available to teach any skill you would like to improve on (i.e. shooting, dribbling) Each skill session will last an hour with a charge of $50. Please let Chelsea Wolf or Erin Geary (CoCamp Directors) know ahead of time if you are interested.
I herby give permission for _____________to participate in the 2012 Centenary College Women’s Basketball Camp. I certify that my daughter is in good physical condition, has been examined within the last 12 months and no medical reason has been found that she cannot participate in this camp. Records show that all immunizations are up to date. I understand that she will be participating in rigorous play and activity. Centenary College Personnel have also been informed of any physical limitations, medications or prior conditions. The camp will safeguard the health of my child but will not be responsible for accidents, injuries or sickness on the way to camp, during camp or on the way home. I agree that in the case of an accident involving my child while attending camp, and with full awareness that basketball is an activity that may involve risk or injury, I release Justin Phoenix and Centenary College from any and all liability. I herby request that my child be granted admittance into the 2012 Centenary College Women’s Basketball Camp and authorize the directors to act on my behalf in the event of an emergency requiring medical attention. I will assume responsibility for payment for any such attention and have provided current insurance information as requested. Camper Name __________________________Age_____ Parent(s) Name(s) ______________________________ Parent(s) Daytime Phone ________________________ Home Phone ____________________________ ______ Emergency Contact _____________________________ Relationship ___________________________________ Contact Phone# ________________________________ Insurance Carrier_______________________________ Policy#_______________________________________ Previous Medical Conditions _______________________
This camp is not responsible for any article/property lost or stolen. This camp is open to any and all entrants (limited only based by number, age, grade level and/or gender.
For more information, please call: (908)852-1400 ext 2341 Or Email: firstname.lastname@example.org email@example.com
By Signing below, I agree to all the terms detailed above Parent/Guardian Signature _________________________ Date_______________