Kirksville Boys Basketball Camps
When: May 28th-May 30thWhere: PRIMARY GYMCamp Staff will be Coaching Staff/Former Players (Alumni)
TIMES:(Grades for 2014-15 school year)8:00 - 10:00 AM (students entering) GRADES 4th -6th10:00 - 12:00 AM (students entering) GRADES 7th -9th
*CAMP IS OPEN TO ALL PLAYERS, NOT JUST KIDS FROM KIRKSVILLE. HOWEVER, IF YOU ARE GOING TO BE A FRESHMAN DURING THE 2014-15 SCHOOL YEAR, YOU MUST ATTEND KIRKSVILLE SR. HIGH.
*PRE-REGISTERED CAMPERS WILL RECEIVE A CAMP T-SHIRT (May 15th 2014)(IF YOU ARE NOT PRE-REGISTERED, YOU WILL NOT RECEIVE A T-SHIRT!)
FORMS AVAILABLE ATWilliam Matthew MS, and Ray Miller Elementary OFFICEORONLINE @ www.kirksville.k12.mo.us -click on link to Ray Miller Elementary or William Matthew Middle School
PRE-REGISTERED COST: $30.00ON-SITE REGISTRATION: $40.00No Refunds Once Paid
Pay with Cash or Check: PLEASE MAKE CHECKS PAYABLE TO TIGER BASKETBALL(Memo Boys Basketball Camp)FORMS CAN BE DROPPED OFF TO THE HIGH SCHOOL OR MAILED TO COACH Martin:Tyler Martin1202 East JeffersonKIRKSVILLE, MO 63501 ** CAMPER INFORMATION**
NAME: _________________________ GRADE FOR 2014-15: __________
AGE: _____ BIRTHDATE: __________
ADDRESS: _____________________ CITY: _________________ ZIP: _______
HOME PHONE #: __________________ EMERGENCY #: _____________________
SHIRT/SHORT SIZE (circle): Youth: 10-12 14-16 Adult: S M L XL XXL(When in doubt on sizes, order a size too big as we do not order extra shirts!)
**Identification and Medical Treatment Authorization**
The undersigned parents and/or guardians of (campers name) ____________________, the applicant, for and in further consideration of the basketball camp acceptation said applicant, does hereby release and discharge Kirksville R-III Schools and it's representatives, employees, and agents from any and all debts, claims, demands, actions, damages, caused of action, judgments, or suits of any kind which may arise or be occasioned as a result of any course of instruction or the applicants participation in the basketball camp. In addition, I/we being the parents and/or guardians of the applicant authorize the Kirksville R-III and it's agents permission to request emergency medical treatment or care as necessary to insure the well being of our dependent. Further, I claim the registrant has had a physical examination in the past year and was found fit for all physical endeavors.
Signature of Parent or Guardian: _________________________ Date: ____________________
Family Health Insurance Provider: ____________________________________________________
Family Health Insurance Policy #: _____________________________________________________
**Camper Code of Conduct Contract**
As a participant in the Kirksville Tiger Basketball Camp, I agree to comply with all of the rules, regulations, and directives of the coaching staff, and I will treat all of the coaching staff and other camp participants with respect, courtesy, and good will. I have read the above statement and understand that failure to comply with that statement may result in my removal from the camp without refund.
Participants Signature: _________________________ Date: ______________________