2018 Basketball Youth Camp

Camp Information

Location : Kearney High Main and Aux Gym

Dates : May 28th-May 30th

Times:

2019-20 School Year Grades

7th-8th Grade - 8:00-10:00 AM

4th-6th Grade - 10:15 AM - 12:15 PM

1st-3rd Grade - 1:00-2:30 PM

Cost : $50

Come in through the athletic entrance (west side). Every camper will receive a T-Shirt for participating in the camp. We will start in the main gym each day. Your camper will receive instruction from Kearney Boys Basketball Staff.

Athlete Information

Athlete's First Name *

Athlete's Last Name *

2019-20 Grade

1st 2nd 3rd 4th 5th 6th 7th 8th

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Shirt Size *

YS YM YL S M L XL

Camp Attending *

7th-8th Grade Camp - 8 AM to 10 AM 4th-6th Grade Camp - 10:15 AM to 12:15 PM 1st-3rd Grade Camp - 1 PM to 2:30 PM

Parent/Guardian Information

Name *

First Name Last Name

Cell Number *

Area Code Phone Number

E-mail *

Emergency Information

Only fill out the emergency contact if different than the guardian contact information.

Emergency Contact's Name

First Name Last Name

Relationship

Phone Number

Area Code Phone Number

Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Kearney High School during the selected camp. In exchange for the acceptance of said child’s candidacy by Kearney High School, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Kearney High School . and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Kearney High School including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

SIGNATURE *

Check the box below and click submit. You will then go to PayPal where you can pay with an account or use a debit/credit card option as a guest. If you didn't receive a confirmation email - we did not get your submission. Please contact me with any questions - draberanek@kearneycats.com Thanks!

My Products *

Camp Registration $ 50.00

Kearney Basketball Youth Camps

Payment Method