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INDIANA GIRLS BASKETBALL CAMPS

June 16, Bloomington, Indiana
at Indiana University

CAMP COSTS

$100.00

CAMP DETAILS

- Open to Girls Ages 8 and older

- Registration - June 16, 11-11:45 a.m. Assembly Hall South Lobby

-  Camp runs 12-5 p.m.

 


All camps open to all and any entrants

FOR REGISTRATION INFORMATION/INQUIRIES:

- Phone: 1-812-855-3013
- E-Mail: For Further Information!
- Register On-Line: Now Available!
- Download Camp Brochure: Click Here!


2013 Father-Daughter Camp

Registration Note: All cancellations and/or request for refunds must be received two weeks prior to the camp start date.If the cancellation notice is received before the above-said deadline, full payment will be returned except a $75 administrative fee.The administrative fee is not refundable for any reason.If the cancellation notice is received after the above-said deadline, no refunds will be given unless there is a medical circumstance in which proper documentation is required.Curt R Miller Basketball Camps, LLC reserves the right to change and/or cancel any camp at any time in which a full refund will be honored.No refunds/Discounts for late arrivals or no shows.
 
Child's Name (Last, First)*
 
Father's Name*
 
Home Address*
 
City*
 
State*
 
Zip*
 
Parent/Guardian E-Mail Address*
 
Camper's Home Phone #*
 
Parent's Cell Phone #
 
Age*
 
Grade Entering (as of Sept. 2013)*
 
T-Shirt Size (adult sizes)*
 S
 M
 L
 XL
 XXL
 
Camper's School*
 
INTERNAL USE - Campers do not fill out next two fields  
Mail In Payment
 

Check Data (Check #, Amount, Date Received)
 

MEDICAL CONSENT FORM
In order to enable the Health Center of Indiana University and/or other health facilities in Bloomington to provide prompt care to your minor daughter,we must have a new completed Medical Consent Form on file each year.This way,we can help your child in an emergency without delay.
 
Name of Minor*
 
Birthdate (Month/Day/Year)*
 
Insurance Company*
 
Policy Number/Group #*
 
Social Security # (if used by insurance)
 
Allergic Reactions
 
Present Medication (include dosage)
 
Date of Last Tetanus Toxoid
 
Any past illness or other information that would be useful in the event of medical treatment
 

EMERGENCY NUMBERS
 
Father's Home Phone #
 
Father's Cell Phone #
 
Mother's Home Phone #
 
Mother's Cell Phone #
 
Name and Phone Number to call if parents cannot be reached
 

WAIVER AND RELEASE
I grant permission to the Directors, Assistants, or other persons responsible for her care to act on my behalf of said minor in granting permission for evaluation and treatment of medical problems. I understand that should a major medical problem arise, an attempt will be made to notify me by telephone. In the event that I cannot be reached, I hereby give consent to such medical treatment as deemed necessary including surgery, x-ray examinations and anesthesia to be rendered to said minor by a licensed physician or nurse.I do hereby waive, release and discharge the Curt R Miller Basketball Camps, LLC and the respective staffs, employees, successors, and assigns, of and from any and all rights and claims for damages resulting from injury of my person or property, which may be sustained or suffered by me in connection with my association with or participating in,or arising out of my traveling to or from the Curt R Miller Basketball Camps,LLC.We,the parents/guardians, agree to the above waiver and release and we join therein.
 

Parent/Guardian Name*
 
Date*
 

PAYMENT OPTIONS
Please select your payment option by indicating a '1' in the quantity field.
We need a registration form and consents completed for each participant.

Note: A charge from Hoosiersportscamps.com will appear on your credit card for your on-line registration. However, if any of the Indiana Girl's Basketball Camps are canceled for any reason, refunds must be collected directly from Curt R Miller Basketball Camps LLC, 1001 E. 17th Street, Bloomington, IN 47408. Phone 812-855-9442.
 
Qty 
 $100.00 Option 1 - Father/Daughter Registration - Payment in Full

 $80.00 Option 2 - Father/Daughter Registration with IU Discount (NOTE: This discount only available to children of IU employees. Valid IU e-mail address required) - Payment in Full

 $50.00 Option 3 - Additional Child Registration (Note: First daughter should register with option 1, and additional daughters can use Option 3. You MUST completely fill out form for each child) - Payment in Full