2017 Matt McMahon
MEDICAL RELEASE FORM Parent’s Name: (Policy Holder Name)
Policy Holder’s Social Security Number: -
Name and Address of Insurance Company:
Policy Number:
Group Number: Any Other Identification: Name & Address of Employer:
I verify the camp applicant is in good health and suffers from no illness, disability or condition that requires the taking of medication on a regular basis, unless the condition is disclosed and approved. I hereby authorize the Directors of Matt McMahon Basketball Camps to act for me-according to their best judgment-in any emergency requiring medical attention. If the camper should disregard the said rules, neither the camper, parent, nor guardian of the camper may hold Matt McMahon, the Murray State basketball camp, or it’s staff responsible for resulting 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 condition of admittance as a camper, and on behalf of the applicant, I hereby release Matt McMahon. Murray State University, all other employees/ agents of the camp from any and all liability from injuries.
Parent/Guardian Signature:
Date:
Detach and Return
Insurance Co. Telephone:
Murray State University
Racer Basketball 1401 State Route 121 N Murray, KY 42071
Camper’s Name:
2017 Matt McMahon Basketball Camps, LLC
June 24, 2017 Located at the CFSB Arena on the campus of Murray State University
For More Information: Tim Kaine Assistant Men’s Basketball Coach
Where:
(270) 809-6746 or [email protected]
When:
Check-in: Camp Cost:
Call the Men’s Basketball Office (270) 809-6804 You can also find more information online at:
Elite Camper Information
CFSB Arena on the campus of Murray State University in Murray, KY Camp begins on June 24 at 1 pm and will end no later than 6 pm the same day. Noon to 1 pm at the CFSB arena $20.00 per Camper Price includes: one meal and a camp t-shirt.
Name: Address:
City, State, Zip: Cell Phone: E-Mail: Age:
** 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
Detach and Return
OR
REGISTRATION FORM
2017 ELITE CAMP
Grade in Fall:
High School/Jr. College: T-Shirt Size: S
M
L
XL
XXL
(Circle One)
Parent/Guardian Information Name: Address:
City, State, Zip: Home Phone: Cell Phone: E-Mail:
For Campers traveling via air, we can assist with transportation to Murray.
15 NCAA appearances—including six times in the past 12 years
Emergency Contact Information Name:
7 NIT appearances
Current NBA Players: Cameron Payne (Chicago Bulls) Isaiah Canaan (Chicago Bulls)
Phone Number:
_________
NOTE: Please fill out BOTH sides of the following form and mail to: Matt McMahon Basketball Camps, LLC 1401 State Route 121 N; Murray, KY 42071 Please make all checks payable to:
Policy Holder’s Social Security Number: -
Name and Address of Insurance Company:
Policy Number:
Group Number: Any Other Identification: Name & Address of Employer:
I verify the camp applicant is in good health and suffers from no illness, disability or condition that requires the taking of medication on a regular basis, unless the condition is disclosed and approved. I hereby authorize the Directors of Matt McMahon Basketball Camps to act for me-according to their best judgment-in any emergency requiring medical attention. If the camper should disregard the said rules, neither the camper, parent, nor guardian of the camper may hold Matt McMahon, the Murray State basketball camp, or it’s staff responsible for resulting 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 condition of admittance as a camper, and on behalf of the applicant, I hereby release Matt McMahon. Murray State University, all other employees/ agents of the camp from any and all liability from injuries.
Parent/Guardian Signature:
Date:
Detach and Return
Insurance Co. Telephone:
Murray State University
Racer Basketball 1401 State Route 121 N Murray, KY 42071
Camper’s Name:
2017 Matt McMahon Basketball Camps, LLC
June 24, 2017 Located at the CFSB Arena on the campus of Murray State University
For More Information: Tim Kaine Assistant Men’s Basketball Coach
Where:
(270) 809-6746 or [email protected]
When:
Check-in: Camp Cost:
Call the Men’s Basketball Office (270) 809-6804 You can also find more information online at:
Elite Camper Information
CFSB Arena on the campus of Murray State University in Murray, KY Camp begins on June 24 at 1 pm and will end no later than 6 pm the same day. Noon to 1 pm at the CFSB arena $20.00 per Camper Price includes: one meal and a camp t-shirt.
Name: Address:
City, State, Zip: Cell Phone: E-Mail: Age:
** 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
Detach and Return
OR
REGISTRATION FORM
2017 ELITE CAMP
Grade in Fall:
High School/Jr. College: T-Shirt Size: S
M
L
XL
XXL
(Circle One)
Parent/Guardian Information Name: Address:
City, State, Zip: Home Phone: Cell Phone: E-Mail:
For Campers traveling via air, we can assist with transportation to Murray.
15 NCAA appearances—including six times in the past 12 years
Emergency Contact Information Name:
7 NIT appearances
Current NBA Players: Cameron Payne (Chicago Bulls) Isaiah Canaan (Chicago Bulls)
Phone Number:
_________
NOTE: Please fill out BOTH sides of the following form and mail to: Matt McMahon Basketball Camps, LLC 1401 State Route 121 N; Murray, KY 42071 Please make all checks payable to:
