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Registration for Girls Basketball Elite Camp

Please fill out the form below to register for Lees-McRae's 2013 Girls' Basketball Elite Camp, scheduled for June 26-27. The camp is offered as a day camp with an emphasis on individual instruction in all facets of the game, as well as position development and several different forms of competition.

The camp is open to players in grades 7-12, and will run from 9 a.m. to 3 p.m. The cost of this camp is $115, including lunch. Each camper will receive a free T-Shirt.

Walk-ins welcome - registration begins at 8 a.m. on first day of camp.

For more information, please contact head women's basketball coach Michele Williams by phone at (828) 898-2482, or assistant coach Ryan Riedel by phone at (828) 898-3431 or by email at riedelr@lmc.edu. Those interested in staying on campus overnight should contact Coach Williams or Coach Riedel.

Personal Information

Email address *

First name *

Last name *

Address 1

Address 2

City

State

ZIP Code

Home Phone

Alternate Phone

Birthdate

Shirt Size *

Covered under Medical Insurance? *

If yes, please specify your provider and policy information in the fields below

Yes
No

Insurance Provider *

Enter N/A if not applicable

Policy Holder Name *

Enter N/A if not applicable

Policy Number *

Enter N/A if not applicable

Custodial Parent/Guardian Information

Registrant is in the custody of

If provided options do not apply, complete the next field

  Both parents
  Mother only
  Father only

Other

Mother/Guardian Name

Daytime Phone

Work Phone

Father/Guardian Name

Daytime Phone

Work Phone

Medical Information

Please list medications *

Please list allergies *

List any known physical limitations or concerns that we should be aware of

Emergency Contact Information (other than guardian)

Full name

Home Address 1

Home Address 2

City

State

Zip

Primary Phone

Alternate Phone

Relationship to camper

Waiver of Responsibility

I agree Lees-McRae College and its athletic department is released from liability in connection with medical treatment and unavoidable accidents. Lees-McRae College Girls' Basketball Elite Camp also has my permission to use necessary medical measures in the event of an emergency, for which I will be financially responsible.

I fully understand the inherent risks involved in the activities my child will be participating in for this basketball camp at Williams Gymnasium. I accept all risks including those activities preliminary and subsequent to the activity.

I do hereby further declare [provide child’s full name below] to be physically sound and suffering from no condition, impairment, disease, infirmity, or other illness that would prevent their participation, with or without reasonable accommodation of any disability, in any of the activities and programs of the Lees-McRae College Girls Basketball Elite Camp. I do hereby assume all responsibility for this child’s participation and activities, and his/her use of equipment in activities. *

Also, I give the Lees-McRae College softball program permission to utilize my child's photograph or likeness in camp promotional materials.

Parent or Guardian Electronic Signature *

Date *

PLEASE MAKE CHECKS PAYABLE TO:

Lees-McRae Athletic Camps

PLEASE MAIL TO
OR BRING TO FIRST DAY OF CAMP CHECK IN:

Lees-McRae College Girls Basketball Elite Camp
Attn: Michele Williams
PO Box 128
Banner Elk, NC 28604

* = required field