2025 Basketball Camp Registration Form

CAMP INFORMATION

All Basketball Camps at LSUS will be operated independently and directed by Head Coach Kyle Blankenship, LSUS Assistant Coaches, and Current and Former LSUS Players.

All camps are open to Ages 5 to 13.

Each camp will begin at 9:00 A.M. and end at 12:00 P.M. daily. Early drop-off is available for an additional fee.

*Payment is due on the first day of camp. Cash, Check, Venmo or CashApp only.

Please Select Which Camp Session You Plan To Attend

School's Out Skills Camp (5/19 - 5/21) - $100Total Skills Camp (6/16 - 6/18) - $100Ball Handling/Shooting (7/9 - 7/10) - $60

Athlete Information

Athlete's Name*

First NameLast Name

Birth Date*

MonthDayYear

Gender*

MaleFemale

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Parent/Guardian Information

Name*

First NameLast Name

Home Number

Area CodeNumber

Cell Number*

Area Code Number

E-mail*

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Area Code Number

Alt. Phone Number

Area CodeNumber

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

Is the athlete prescribed an inhaler? If yes, please explain any instructions.*

LSUS Camp Participant Permission & Release/Waiver of Liability

It is to my understanding that the student participating in the camps at LSUS Athletics is a privilege. I acknowledge that participation in these activities may inherent certain risks, including physical injury due to activity related accidents, illness, or even death. I also understand that there may be other risks due to these activities that I may not be aware of at this time.

Release of Liability Waiver

By signing this Waiver Form, I acknowledge that the student listed above is capable of participating in the activities. I also assume all risks of the student participating in the activities, whether such risks are known or unknown to me at this time. I release and hold harmless this organization, leaders, volunteers, and any agents from any claim the student or I may have due to the result of any injury or illness incurred during participation of the Basketball camps at LSUS. I accept and assume full responsibility for any and all injuries, damages, and losses that may occur to me from any participation in the camp activities.

First Aid and Medical Treatment

I understand that the student may be in need of first aid or emergency medical treatment due to an accident, illness, or other health conditions. I give permission for the appropriate personnel of the organization to seek and secure any needed medical attention or treatment for the student including hospitalization (if personnel feels necessary). I accept and agree to pay for any fees incurred due to accident or illness.

I acknowledge there is a risk of being injured that is inherent in all sports activities, including basketball, and that the forenamed child is covered by medical insurance as follows:

Insured:

Company:

Policy Number:

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.

E-Signature*

Summer Basketball Camps