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TOM CREAN BASKETBALL CAMPS

LITTLE HOOSIERS BASKETBALL ACADEMY SESSION III

Open to Boys and Girls Grades K-3

July 21-23, 2014, Bloomington, Indiana, at Indiana University

9 a.m. - 12 p.m. Each Day

CAMP COSTS

$165.00

CAMP DETAILS

- drop-off available at 8:30 a.m. each day

- Each camper receives a t-shirt, basketball and mid-morning snack

- Water and Gatorade will also be provided


All camps open to all and any entrants

FOR ADDITIONAL INFORMATION:


- Phone: 1-812-855-2238
- E-Mail: For Further Information!
- Register On-Line: Coming Soon!
- Download Camp Brochure: Coming Soon!



2014 Little Hoosiers Basketball Academy Session III

Registration Note Registrations will be accepted until the camp is full. No refunds or cancellations will be accepted once camp starts. Cancellations received before July 1 will receive a full refund minus a $25 administrative fee. Cancellations received from July 1 until camp opens will be refunded their camp payment minus a $100 late cancellation fee.

Once you have submitted your registrations you will receive a confirmation letter, complete camp information, a campus map and a medical history form that should be filled out and brought with you to registration. You also will be required to bring a physician's statement or a copy of your school or athletic physical. If you have questions, please call 812-855-2238.

Please complete the form below and submit camp payment. If you are registering more than one child, please complete a form for each camper.

 
Camper's Name (Last, First)*
 
Home Address*
 
City*
 
State*
 
Zip*
 
Gender*
 Male
 Female
 
Parent/Guardian Name(s)*
 
Camper's Home Phone #*
 
Parent's E-Mail Address*
 
Please Note: Registration communication will come via e-mail, so please be sure to send accurate e-mail address  
Age*
 
Grade Entering (as of Aug. 2014)*
 
T-Shirt Size*
 Y-S
 Y-M
 Y-L
 S
 M
 L
 XL
 XXL
 

EMERGENCY NUMBERS  
Mother's Home Phone #
 
Mother's Cell Phone #
 
Mother's Work Phone #
 
Father's Home Phone #
 
Father's Cell Phone #
 
Father's Work Phone #
 
Name and phone number to call if parent/guardian(s) can't be reached*
 

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

* I grant permission to the Directors, Assistants, or other persons responsible for his care to act on my behalf for 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.)  

* By my submission of this registration, I represent that I am either 18 years of age or older, or that I am the parent or legal guardian of the registrant (if he/she is under age 18). I represent I have read the terms of the Privacy Policy, that I understand the manner in which the information collected about the registrant may be used, and that I agree to the use of the registrant’s personally identifiable information in the manner described in the Privacy Policy.  

* Waiver: I do hereby waive, release and discharge the Tom Crean Basketball Camps, Forward Marketing 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 Indiana Basketball Camp. We, the parents/guardians, agree to the above waiver and release and we join therein.  

* After completing my registration, I understand that if I later determine that I want to transfer to another camp and/or to another session of the same camp, a $25 transfer fee will be assessed.  

Parent/Guardian Name*
 

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 the IU Basketball Camp is cancelled for any reason, refunds must be collected directly from the IU Basketball Camp, Phone 812-855-2238.
 
Qty 
 $165.00 Individual Registration - Payment in Full