2018 Instructional Basketball League Registration Form

PENN BOYS BASKETBALL ELEMENTRAY CAMP (2024-25 School Year)

JUNE 23-26, 2025 | 1:30-3pm | Penn HS| $80 Registration Fee | For Boys in Grades K -3rd | Includes All Camp Instruction, Camp T-shirt, and Camp Basketball
PLAYER REGISTRATION

Please complete all sections below.
Grade Level*
As of 2024-25 school year
Graduating Class/Year*
Player Name*

First NameLast Name
T-Shirt Size*
School Child Attends
As of 2024-25 school year
Does your child(s) have any allergies, chronic illness, mental illness, or medical conditions that would limit high level activity?*

YesNo
If you answered "Yes" to the question above, please explain here:
GUARDIAN INFORMATION

Please complete all sections below.
Guardian / Parent Name *
Primary Phone*
E-mail*
example@example.com
Emergency Contact Information
Emergency Contact's Name *
Relationship*
Phone Number*

RELEASES

Please complete all sections below.
Permission For Emergency Medical Treatment As the legal parent or guardian, in the event of illness or accident, I give consent for the Kingsmen Elite, LLC, members of the Penn High School Basketball Coaching Staff to secure any and all necessary emergency medical care for my child. The undersigned gives permission to the Kingsmen Elite, LLC, its owners and operators and members of the Penn High School 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 the Hospital 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
Release of Liability As the legal parent or guardian, I release and hold harmless the Kingsmen Elite, LLC, its owners and operators, members of the Penn High School Basketball Coaching Staff and Players, and the Penn-Harris-Madison 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 the Kingsmen Elite, LLC, its owners and operators or in route to or from any of said premises.
I have read and agree to the above conditions of the Release of Liability*

Yes
Social Media Release: As the legal parent or guardian, I grant permission for Penn Boys Basketball and the Kingsmen Elite, LLC to utilize my player's photo or video footage to promote the program using various social media outlets.
I have read and agree to the above conditions of the Social Media Release*

Yes
Is there anything else you'd like to communicate as it relates to this Camp registration?

Confirmation E-mail*
example@example.com
If you have any questions, please contact Coach Coolman: bcoolman@phm.k12.in.us NOTE** Discounted price available for students that qualify for Free and Reduced Lunch. Please Contact Coach Coolman for details.

CAMP PAYMENT HERE*

PRICE PER PLAYER2025 Elementary Basketball Camp Boys Grades K to 3rd

$80.00 NUMBER OF PLAYERS
Item subtotal:$0.00

Enter coupon

Total

$0.00

Please Note: The name of Coach Coolman's camp and basketball LLC was "Valparaiso Basketball Skills Academy, LLC" and is being changed to "Kingsmen Elite, LLC".
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PENN BOYS BASKETBALL ELEMENTRAY CAMP (2024-25 School Year)

PLAYER REGISTRATION

GUARDIAN INFORMATION

RELEASES