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June 7-8, Bloomington, Indiana
at Indiana University




- Open to Girls Grades K-4

- Registration - June 7, 12:30-1 p.m. Assembly Hall South Lobby

-  Camp runs 1-4 p.m. daily


All camps open to all and any entrants


- E-Mail: For Further Information!
- Register On-Line: Now Available!

2014 Young Hoosiers 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 $20 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.
Camper's Name (Last, First)*
Home Address*
Parent/Guardian Name(s)*
Parent's E-Mail Address*
Camper's Home Phone #*
Parent's Cell Phone #
T-Shirt Size*
Camper's School*

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

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*

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, 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 the Curt R Miller Basketball Camps,LLC.We,the parents/guardians, agree to the above waiver and release and we join therein.

* 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.  

Parent/Guardian Name*

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 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 812-855-3013.
 $100.00 Option 1 - Individual Camper - Payment in Full