YOUTH CAMP - JUNE 23-25

2026 TRUMAN STATE MEN'S BASKETBALL
YOUTH CAMP: ENTERING GRADES 3-8
JUNE 23-25
PRICE: $175 PER CAMPER
SESSION 1

Entering 3rd to 5th Grade

8:30 AM to 11:30 AM
SESSION 2

Entering 6th to 8th Grade

3:30 PM to 6:15 PM
CAMPERS WILL RECEIVE T-SHIRT & TRUMAN STATE BASKETBALL
CAMPER INFORMATION
Full Name*

First NameLast Name
DOB:*

MonthDayYear
Date
High School/Middle School:
Entering Grade Level:*
Shirt Size:*
Adult S/M/L/XL or Youth S/M/L
Session #:*
Session 1 or Session 2
Primary Parent/Guardian (Emergency Contact)
Primary Parent/Guardian Name:*

First NameLast Name
Relationship:
Email Address:*
Phone Number:*
Format: (000) 000-0000.
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Secondary Parent/Guardian (Not Required)
Secondary Parent/Guardian Name:

First NameLast Name
Relationship:
Email Address:
example@example.com
Phone Number:
Format: (000) 000-0000.
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Insurance Information
Insurance Member's Name:
Member ID:
Group ID:
Health Insurance Provider:
Health Insurance Provider Phone Number:
Format: (000) 000-0000.
General Health Information
List any health information that would be relevant to an attending physician in the case of an emergency:
Parent/Guardian has read attached the GENERAL RELEASE AND INDEMNITY AGREEMENT signed by Parent/Legal GuardianParent/Guardian has read and agreed to the PERMISSION TO TREAT Statement
Parent/Guardian Signature:*
Date:*

MonthDayYear
Date
Venmo - @HigherAimCampsCash App - $HigherAimCampsApple Pay - (660) 956-1017Cash or Check (payable to Higher Aim Camps)
IF YOU HAVE ANY QUESTIONS OR CONCERNS CONTACT: HIGHERAIMCAMPS@GMAIL.COM or (660) 956-1017

Mail Checks to Higher Aim Camps:

2306 North East Street,

Kirksville, MO 63501

PARENT/LEGAL GUARDIAN RELEASE FOR MINOR PARTICIPANT
MINOR (Under Age 18) PARTICIPANT'S NAME:*
Full Name
DATE OF BIRTH:*

MonthDayYear
Date
CAMP NAME:*
EMERGENCY CONTACT:*
PHONE*
Format: (000) 000-0000.
BY SIGNING THIS DOCUMENT, YOU ARE WAIVING CERTAIN LEGAL RIGHTS. READ CAREFULLY BEFORE SIGNING
GERNERAL RELEASE AND INDEMNITY AGREEMENT
I hereby represent that I am the parent or legal guardian of "PARTICIPANT," who is under the age of 18. For and in consideration of Truman State University permitting PARTICIPANT to participate voluntarily in Truman State Youth Camp to be June 23-26, 2026, on Truman State University campus in Kirksville, Missouri, hereafter referred to as "TEAM CAMP", I hereby expressly assume all the risks (e.g. sprains, contusions, broken bones, head injuries, and death) inherent in the TEAM CAMP's outdoor and indoor activities, and I release Truman State Youth Camps, Mike Worley, all its employees and coaches, and Truman State University, its regents, officers, employees, students, and agents (collectively, the "RELEASED PARTIES") from all claims, demands, suits, causes of action, or judgments which I ever had, now have, or may have in the future or which my heirs, executors, administrators, or assigns may have, or claim to have against the RELEASED PARTIES, arising out of or in any way connected with the TEAM CAMP, for all personal injuries, known or unknown, property damages, or claims for wrongful death, caused by the ACTS, OMISSIONS, OR NEGLIGENCE of the RELEASED PARTIES. I understand this waiver does not apply to injuries caused by the RELEASED PARTIES' intentional or grossly negligent conduct. I further agree to indemnify and hold harmless RELEASED PARTIES from all claims, demands, suits, causes of action, or judgments which participant or I ever had, now have, or may have in the future or which our heirs, executors, administrators, or assigns may have, or claim to have against RELEASED PARTIES, arising out of or in any way connected with the TEAM CAMP, for all personal injuries, known, or unknown, property damages (including lost or stolen property), or claims for wrongful death, caused by the acts, omissions or negligence of RELEASED PARTIES, and to defend, in the names of the RELEASED PARTIES, and at my own expense, any such claims, demands, suits, causes of action or judgments described above. I also agree to be responsible for any property damage or personal injuries that participant or I may cause by intentional or negligent acts while participating in the TEAM CAMP.
PHOTO RELEASE
I hereby grant to the RELEASED PARTIES the right to reproduce, use, exhibit, display, broadcast, distribute and create derivative works of university related photographs or videotaped images of PARTICIPANT for use in connection with the activities of the university or for promoting, publicizing, or explaining the school or its activities. This grant includes, without limitation, the right to publish such images in the university's student newspaper, alumni magazine, publications on the university's Web site, and public relations/promotional materials. These images may appear in any of the wide variety of formats and media now available to the school and that may be available in the future, including but not limited to print, broadcast, videotape, CD-ROM, and electronic/online media. All photos taken are without compensation to PARTICIPANT. All electronic or non-electronic negatives, positives, and prints are owned by the university. I have read and executed this document with full knowledge of its legal significance.
PARENT/LEGAL GUARDIAN SIGNATURE:*
DATE:*

MonthDayYear
Date
Parent/Legal Guardian Name*
Minor Participant's Mailing Address:
Street Address City/State

PERMISSION TO TREAT STATEMENT
I or MY CHILD plan to attend a Truman State University Camp, hereinafter referred to as "CAMP". I fully realize that injury or illness could result from or during MY or MY CHILD'S participation in the CAMP. In case of accident or illness, I give my permission to Truman State to provide to ME or MY CHILD medical treatment as deemed appropriate, including transportation, by ambulance if necessary, to a hospital or emergency room. I understand that Truman State will not be responsible for any medical expenses incurred in providing treatment, and I will assume responsibility for any medical expenses incurred in providing treatment to ME or MY CHILD, including expenses that are not covered by insurance.
Should be Empty:

CAMPER INFORMATION

Primary Parent/Guardian (Emergency Contact)

Secondary Parent/Guardian (Not Required)

Insurance Information

General Health Information

PARENT/LEGAL GUARDIAN RELEASE FOR MINOR PARTICIPANT

GERNERAL RELEASE AND INDEMNITY AGREEMENT

PHOTO RELEASE

PERMISSION TO TREAT STATEMENT