2015 Elite Brochure (2)
MEDICAL RELEASE FORM
(Policy Holder Name)
Policy Holder’s Social Security Number: ‐ ‐
Name and Address of Insurance Company:
Insurance Co. Telephone:
Policy Number:
Group Number:
Name & Address of Employer:
Any Other Iden fica on:
I verify the camp applicant is in good health and suffers from no illness, disability or condi on that requires the taking of medica on on a regular basis, unless the condi on is disclosed and approved. I hereby authorize the Directors of Steve Prohm Basketball Camps to act for me‐according to their best judgment‐in any emergency requiring medical a en on. If the camper should disregard the said rules, neither the camper, parent, nor guardian of the camper may hold Steve Prohm, the Murray State basketball camp, or it’s staff responsible for resul ng consequences. I, the undersigned hereby expressively agree to be responsible for any medical bill incurred in the treatment, or any illness, or accident (mental or physical). Also, as a condi on of admi ance as a camper, and on behalf of the applicant, I hereby release Steve Prohm. Murray State University, all other employees/ agents of the camp from any and all liability from injuries.
Parent/Guardian Signature: Date:
Elite Basketball Camp, LLC
Detach and Return
Murray State University
Racer Basketball 1401 State Route 121 N Murray, KY 42071
Camper’s Name: Parent’s Name:
2015 Steve Prohm
June 27, 2015 Located at the CFSB Arena on the campus of Murray State University
For More Information: (270) 809‐6804 or [email protected]
OR Call the Men’s Basketball Office (270) 809‐6804 or 1 (800) 669‐0088 You can also find more informa on online at GoRacers.com
Where: CFSB Arena on the campus of Murray State University in Murray, KY When: Camp begins on June 27 at 1 pm and will end at 6 pm the same day. Check‐in: Noon to 1 pm at the CFSB arena Camp Cost: $20.00 per Camper Price includes: one meal and a camp t‐shirt. ** Elite Camp is open to rising 10th graders to rising junior college sophomores**
Join our Racer Tradition of Champions 24 Ohio Valley Conference Championships—the most of any school in the league 15 NCAA appearances—including six mes in the past 12 years 7 NIT appearances 28 Consecu ve Winning Seasons— currently the 4th longest streak in the country 2 Conference tles in last 4 years
For Campers traveling via air, we can assist with transporta on to Murray.
Elite Camper Informa on
Detach and Return
James Kane Assistant Men’s Basketball Coach
REGISTRATION FORM
2015 ELITE CAMP
Name: Address: City, State, Zip: Cell Phone: E‐Mail: Age: Grade in Fall: High School/Jr. College: T‐Shirt Size: S M L XL XXL 3X (Circle One)
Parent/Guardian Informa on Name: Address: City, State, Zip: Home Phone: Cell Phone: E‐Mail:
Emergency Contact Informa on Name: Phone:
NOTE: Please fill out BOTH sides of the following form and mail to: Steve Prohm Basketball Camps, LLC 1401 State Route 121 N; Murray, KY 42071
Please make all checks payable to: Steve Prohm Basketball Camps, LLC
(Policy Holder Name)
Policy Holder’s Social Security Number: ‐ ‐
Name and Address of Insurance Company:
Insurance Co. Telephone:
Policy Number:
Group Number:
Name & Address of Employer:
Any Other Iden fica on:
I verify the camp applicant is in good health and suffers from no illness, disability or condi on that requires the taking of medica on on a regular basis, unless the condi on is disclosed and approved. I hereby authorize the Directors of Steve Prohm Basketball Camps to act for me‐according to their best judgment‐in any emergency requiring medical a en on. If the camper should disregard the said rules, neither the camper, parent, nor guardian of the camper may hold Steve Prohm, the Murray State basketball camp, or it’s staff responsible for resul ng consequences. I, the undersigned hereby expressively agree to be responsible for any medical bill incurred in the treatment, or any illness, or accident (mental or physical). Also, as a condi on of admi ance as a camper, and on behalf of the applicant, I hereby release Steve Prohm. Murray State University, all other employees/ agents of the camp from any and all liability from injuries.
Parent/Guardian Signature: Date:
Elite Basketball Camp, LLC
Detach and Return
Murray State University
Racer Basketball 1401 State Route 121 N Murray, KY 42071
Camper’s Name: Parent’s Name:
2015 Steve Prohm
June 27, 2015 Located at the CFSB Arena on the campus of Murray State University
For More Information: (270) 809‐6804 or [email protected]
OR Call the Men’s Basketball Office (270) 809‐6804 or 1 (800) 669‐0088 You can also find more informa on online at GoRacers.com
Where: CFSB Arena on the campus of Murray State University in Murray, KY When: Camp begins on June 27 at 1 pm and will end at 6 pm the same day. Check‐in: Noon to 1 pm at the CFSB arena Camp Cost: $20.00 per Camper Price includes: one meal and a camp t‐shirt. ** Elite Camp is open to rising 10th graders to rising junior college sophomores**
Join our Racer Tradition of Champions 24 Ohio Valley Conference Championships—the most of any school in the league 15 NCAA appearances—including six mes in the past 12 years 7 NIT appearances 28 Consecu ve Winning Seasons— currently the 4th longest streak in the country 2 Conference tles in last 4 years
For Campers traveling via air, we can assist with transporta on to Murray.
Elite Camper Informa on
Detach and Return
James Kane Assistant Men’s Basketball Coach
REGISTRATION FORM
2015 ELITE CAMP
Name: Address: City, State, Zip: Cell Phone: E‐Mail: Age: Grade in Fall: High School/Jr. College: T‐Shirt Size: S M L XL XXL 3X (Circle One)
Parent/Guardian Informa on Name: Address: City, State, Zip: Home Phone: Cell Phone: E‐Mail:
Emergency Contact Informa on Name: Phone:
NOTE: Please fill out BOTH sides of the following form and mail to: Steve Prohm Basketball Camps, LLC 1401 State Route 121 N; Murray, KY 42071
Please make all checks payable to: Steve Prohm Basketball Camps, LLC
