2024 Chesterton Girls Elementary Basketball Camp Registration

ELEMENTARY GIRLS CAMP

K-4th GRADES

May 20th - 23rd

5:00pm-6:30pm

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HELD AT THE

CHESTERTON HIGH SCHOOL MAIN GYM & BALCONY GYM

REGISTER ONLINE BELOW OR IN PERSON ON MAY 20TH BEGINNING AT 4:30PM

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AT THE CONCLUSION OF CAMP EACH NIGHT, CAMPERS CAN BE PICKED UP OUTSIDE THE MAIN GYM ENTRANCE IN THE LOBBY OF CHESTERTON HIGH SCHOOL
INSTRUCTION: COACH WILSON, HER STAFF, AND CHS PLAYERS WILL TEACH THE FUNDAMENTALS OF THE GAME OF BASKETBALL, POSITION WORK, AS WELL AS THE SPECIFIC SKILLS ASSOCIATED WITH OUR PROGRAMS OFFENSES AND DEFENSES.

AWARDS: EACH GIRL WILL RECEIVE A CAMP T-SHIRT, BALL, AND A SKILLS WORK-OUT GUIDE WITH DIGITAL LINKS TO ACCESS WITH YOUR PHONE, TABLET, OR COMPUTER.

Guardian / Parents Names*

First NameLast Name
Cell Phone*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*

EMERGENCY CONTACT & HEALTH INSURANCE INFORMATION
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*

Area CodePhone Number
Insurance Carrier*
Insurance Policy Holders Name*

First NameLast Name
EMERGENCY CONTACT & HEALTH INSURANCE INFORMATION
As the legal parent or guardian, in the event of illness or accident, I give consent for the Chesterton Girls Basketball LLC, members of the Chesterton High School Girls Basketball Coaching Staff to secure any and all necessary emergency medical care for my child. The undersigned gives permission to Chesterton Girls Basketball LLC., its owners and operators and members of the Chesterton High School Girls Basketball Coaching staff to seek medical treatment for the participant in the event they are not able to reach a parent or guardian. I request that my child be transported to Northwest Health Porterl in the event of an emergency. I hereby declare we have listed any physical/mental problems, restrictions, or conditions and/or declare the participant to be in good enough physical and mental health to participate in basketball practice and games.
I have read and agree to the above conditions of the Permission For Emergency Medical Treatment:*

Yes
SOCIAL MEDIA/WEB RELEASE:
As the legal parent or guardian, I grant permission for the Chesterton Girls Basketball Program to utilize my daughter's photo or video footage to promote the program using various social media outlets and/or websites.
I have read and agree to the above conditions of the Social Media Release:*

Yes, I grant permission.No, I do not grant permission and wish for her to be excluded.
RELEASE OF LIABILITY:
As the legal parent or guardian, I release and hold harmless Chesterton Girls Basketball LLC, its owners and operators, members of the Chesterton High School Girls Basketball Coaching Staff and Players, and the Duneland School Corporation from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the control and supervision of Chesterton Girls Basketball LLC, its owners and operators or in route to or from any of said premises.
I have read and agree to the above conditions for the Release of Liability:*

Yes
Confirmation E-mail*
Signature*

Clear

CAMP PAYMENT
CAMP PAYMENT *
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Girls Basketball Camp Pay Here. Choose number of campers from the drop down option $65.00

Quantity
Item subtotal:$0.00

Subtotal $0.00Tax $0.00Total $0.00
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CAMPER #1 INFORMATION

CAMPER #2 INFORMATION

CAMPER #3 INFORMATION

EMERGENCY CONTACT & HEALTH INSURANCE INFORMATION

EMERGENCY CONTACT & HEALTH INSURANCE INFORMATION

SOCIAL MEDIA/WEB RELEASE:

RELEASE OF LIABILITY:

CAMP PAYMENT