application parental permit release & waiver camp objective
APPLICATION TO ENROLL: Please fill out the information below and return by June 1 to:
Bama Hoops Basketball Camp, Inc. BOX 870393 Tuscaloosa, AL 35487-0393 Phone: (205) 348-4551 Fax: (205) 348-7417 * Please include only one child per application.
Name________________________________________ Age________ Grade Next Year __________________ Address _____________________________________ City _________________ State ______ Zip _________ School ______________________________________ Mother ________________ Father ________________ H( W( C(
)____________ H ( )____________ W ( )____________ C (
)____________ )____________ )____________
Roommate Preference __________________________ (Both campers must be pre-registered for camp for their request to be honored.)
CHECK CAMP YOU WISH TO ATTEND: (Ages first grade up to seniors to be eligible)
□ □
□
Parent / Child Camp □ Boarding □ Non-Boarding Individual Camp I □ Boarding □ Non-Boarding Day Camp Shooting Camp I Individual Camp II □ Boarding □ Non-Boarding Shooting Camp II
(June 8-9) $205 $195 $325 $265 $105 $75 $325 $265 $75
PARENTAL PERMIT
Signed:___________________________________________ Relationship: ______________________________________
RELEASE & WAIVER In consideration of my child’s/dependent’s participation in the Bama Hoops, Inc. basketball camp, I do hereby, for myself, my child/dependent, my heirs and executors, waive release and forever discharge all rights and claims for damages and/or injuries for which I or my child/dependent may have, or which may hereafter accrue to me or my child/dependent against Coach Gottfried and its employees and agents, and the University of Alabama, for any and all injuries and/or damages which may be suffered by my child/dependent in connection with my child’s/dependent’s participation. Additionally, I hereby provide a grant of license and a release to use the name and photograph of my child as required to publicize the camp for a period of two years from the date of this release. I have read and understand the release and waiver of claims statement and fully agree with the provisions of this document. ______________________________________________________________ Date
(June 10-13)
______________________________________________________________ Signature of Parent/guardian
(June 11-13) (June 13) (June 17-20)
_(______________)______________________________________________ Daytime Phone
(June 20)
1.) ___________________________________________________________
_(______________)______________________________________________ Evening Phone
2.) ___________________________________________________________ Name of children and / or dependents attending camp.
MEDICAL STATEMENT
DEPOSIT/DEADLINE Please send in your application form and payment by June 1, 2007. *Make Checks payable to: BAMA Hoops, Inc. To verify availability for late registration, call (205) 348-4551. VISA
MASTERCARD
Amount $________ Exp. Month: __________ Exp. Year: ______ Acct. Number: _________-__________-__________-_________ Biller’s Address: __________________ Biller’s Zip: ___________ Signature: ____________________________________________
CAMP OBJECTIVE
The law requires that parental permission be obtained for operative procedures on minors. The following consent form should be signed by parents so that no unnecessary delays will occur with operative procedures. However, no operation will be performed, except emergency, without parents being contacted and fully informed. I, as the parent or legal guardian, have actual knowledge and appreciation of the particulars of the camp including those risks involved in participation in basketball camp, and hereby voluntarily consent to said minor’s participation and assume the risks arising therefrom.
Attach a copy of your previous years basketball physical to this form or have your physician fill out the following medical statement. ALL participants must submit a physical for us to keep on file or have the below completed.
PHYSICIAN’S STATEMENT I hereby certify that I examined_____________________________________ and found him physically fit to attend and participate in the Bama Hoops, Inc. basketball camp, and I know of no impairments which would limit his participation in all activities in camp. Comments: ____________________________________________________ ______________________________________________________________ Date of last tetanus immunization:___________________________________ Date examined:_________________________________________________ Physician’s Name:_______________________________________________
STAFF INFORMATION Coach Mark Gottfried will be assisted by the entire Alabama basketball staff, Tom Asbury, Philip Pearson, and James Holland. Combined, they offer a wealth of coaching and camp experience in developing young players on and off the floor. Other camp workers will include University of Alabama team members, former Alabama greats, as well as some of the best high school coaches in the Southeast.
PLAYING FACILITIES
The newly renovated Coleman Coliseum will serve as the main playing facility, along with the Student Recreation Center. There are four completely air conditioned courts in the Coliseum. The Student Recreation Center is a 200,000 square foot facility. With the 2004 renovations, there are five new high school sized courts. that are fully air conditioned with wood flooring.
FOOD & HOUSING
Campers will eat through Bama Dining Services and Mary Burke Cafeteria. The newly remodeled cafeteria offers a wide range of great choices from homestyle meals and deli sandwiches to fast food and snacks. Boarding campers will reside in University of Alabama Housing Properties. A $25 cash/check key deposit is required at check in and will be refunded upon key return at the end of camp.
CAMP INFORMATION Spending Money: The basketball camp staff will run a Camp Bank so campers will not have to keep up with their money during the week. Campers will have access to the Camp Store where they can purchase an assortment of the following: soft drinks, Gatorade, snacks, pizza (at night), and t-shirts. Clothing: Each Camper must provide his own bed sheets, blankets, pillow, pillowcase, towels, toiletries, basketball shoes, socks, shorts, and t-shirts. Discipline: Any serious violation of camp rules or regulations could result in immediate dismissal from camp. There will be no refund of tuition in this case. Insurance: Each basketball camp participant is required to provide their own medical insurance. A professional trainer is on duty at all times. Doctors are on call 24 hours a day. Because of the rigorous schedule, each camper should come to camp in good physical condition. Cancellation/Refund Policy: A notice of camper cancellation/request must be sent in writing in order to be valid for a refund. There will be an administration fee for all cancellations with the remaining balance being refunded. Fees are as follows: Individual Camp $100, Shooting Camp $25, all other camps $50. Registration: Registration will take place at Coleman Coliseum. From registration campers will go to the dorm to move in. Emergencies: In case of an extreme emergency, please call (205) 348-4516 or (205) 348-5454.
GOTTFRIED’S CAMP
Individual Camp I: June 10-13 Individual Camp II: June 17-20 Participate in fundamental instruction while learning the basics including: working on your ball handling, passing, shooting, team play, and defense. Ages 9 - High School………………………..…$325 Sunday Check-in from 3-5 p.m. & Wednesday finish at 11:30 a.m. with an Award’s Ceremony. Day Camp: June 11-13 Learn the basic rules and fundamentals of the game through participation in many different basketball activities. Ages 5 - 12…………..………………………...…$105 8:30 - 11:30 a.m. Daily Shooting Camp I: June 13 Shooting Camp II: June 20 Fundamental instruction on the basics of shooting, from highly qualified instructors. Ages 5 - High School….………………………....$75 1 - 5 p.m.
BAMA Hoops, INC. BOX 870393 Tuscaloosa, AL 35487-0393
Parent Child Camp: June 8-9 A weekend camp for an adult and child to develop a bond through the sport of basketball. Instructions will be given to adults to assist in the teaching of drills for their children. Ages 5 - High School….….…………………….$205 Friday Check-in at 5 p.m. & Saturday finish at 5 p.m.
Bama Hoops Basketball Camp, Inc. BOX 870393 Tuscaloosa, AL 35487-0393 Phone: (205) 348-4551 Fax: (205) 348-7417 * Please include only one child per application.
Name________________________________________ Age________ Grade Next Year __________________ Address _____________________________________ City _________________ State ______ Zip _________ School ______________________________________ Mother ________________ Father ________________ H( W( C(
)____________ H ( )____________ W ( )____________ C (
)____________ )____________ )____________
Roommate Preference __________________________ (Both campers must be pre-registered for camp for their request to be honored.)
CHECK CAMP YOU WISH TO ATTEND: (Ages first grade up to seniors to be eligible)
□ □
□
Parent / Child Camp □ Boarding □ Non-Boarding Individual Camp I □ Boarding □ Non-Boarding Day Camp Shooting Camp I Individual Camp II □ Boarding □ Non-Boarding Shooting Camp II
(June 8-9) $205 $195 $325 $265 $105 $75 $325 $265 $75
PARENTAL PERMIT
Signed:___________________________________________ Relationship: ______________________________________
RELEASE & WAIVER In consideration of my child’s/dependent’s participation in the Bama Hoops, Inc. basketball camp, I do hereby, for myself, my child/dependent, my heirs and executors, waive release and forever discharge all rights and claims for damages and/or injuries for which I or my child/dependent may have, or which may hereafter accrue to me or my child/dependent against Coach Gottfried and its employees and agents, and the University of Alabama, for any and all injuries and/or damages which may be suffered by my child/dependent in connection with my child’s/dependent’s participation. Additionally, I hereby provide a grant of license and a release to use the name and photograph of my child as required to publicize the camp for a period of two years from the date of this release. I have read and understand the release and waiver of claims statement and fully agree with the provisions of this document. ______________________________________________________________ Date
(June 10-13)
______________________________________________________________ Signature of Parent/guardian
(June 11-13) (June 13) (June 17-20)
_(______________)______________________________________________ Daytime Phone
(June 20)
1.) ___________________________________________________________
_(______________)______________________________________________ Evening Phone
2.) ___________________________________________________________ Name of children and / or dependents attending camp.
MEDICAL STATEMENT
DEPOSIT/DEADLINE Please send in your application form and payment by June 1, 2007. *Make Checks payable to: BAMA Hoops, Inc. To verify availability for late registration, call (205) 348-4551. VISA
MASTERCARD
Amount $________ Exp. Month: __________ Exp. Year: ______ Acct. Number: _________-__________-__________-_________ Biller’s Address: __________________ Biller’s Zip: ___________ Signature: ____________________________________________
CAMP OBJECTIVE
The law requires that parental permission be obtained for operative procedures on minors. The following consent form should be signed by parents so that no unnecessary delays will occur with operative procedures. However, no operation will be performed, except emergency, without parents being contacted and fully informed. I, as the parent or legal guardian, have actual knowledge and appreciation of the particulars of the camp including those risks involved in participation in basketball camp, and hereby voluntarily consent to said minor’s participation and assume the risks arising therefrom.
Attach a copy of your previous years basketball physical to this form or have your physician fill out the following medical statement. ALL participants must submit a physical for us to keep on file or have the below completed.
PHYSICIAN’S STATEMENT I hereby certify that I examined_____________________________________ and found him physically fit to attend and participate in the Bama Hoops, Inc. basketball camp, and I know of no impairments which would limit his participation in all activities in camp. Comments: ____________________________________________________ ______________________________________________________________ Date of last tetanus immunization:___________________________________ Date examined:_________________________________________________ Physician’s Name:_______________________________________________
STAFF INFORMATION Coach Mark Gottfried will be assisted by the entire Alabama basketball staff, Tom Asbury, Philip Pearson, and James Holland. Combined, they offer a wealth of coaching and camp experience in developing young players on and off the floor. Other camp workers will include University of Alabama team members, former Alabama greats, as well as some of the best high school coaches in the Southeast.
PLAYING FACILITIES
The newly renovated Coleman Coliseum will serve as the main playing facility, along with the Student Recreation Center. There are four completely air conditioned courts in the Coliseum. The Student Recreation Center is a 200,000 square foot facility. With the 2004 renovations, there are five new high school sized courts. that are fully air conditioned with wood flooring.
FOOD & HOUSING
Campers will eat through Bama Dining Services and Mary Burke Cafeteria. The newly remodeled cafeteria offers a wide range of great choices from homestyle meals and deli sandwiches to fast food and snacks. Boarding campers will reside in University of Alabama Housing Properties. A $25 cash/check key deposit is required at check in and will be refunded upon key return at the end of camp.
CAMP INFORMATION Spending Money: The basketball camp staff will run a Camp Bank so campers will not have to keep up with their money during the week. Campers will have access to the Camp Store where they can purchase an assortment of the following: soft drinks, Gatorade, snacks, pizza (at night), and t-shirts. Clothing: Each Camper must provide his own bed sheets, blankets, pillow, pillowcase, towels, toiletries, basketball shoes, socks, shorts, and t-shirts. Discipline: Any serious violation of camp rules or regulations could result in immediate dismissal from camp. There will be no refund of tuition in this case. Insurance: Each basketball camp participant is required to provide their own medical insurance. A professional trainer is on duty at all times. Doctors are on call 24 hours a day. Because of the rigorous schedule, each camper should come to camp in good physical condition. Cancellation/Refund Policy: A notice of camper cancellation/request must be sent in writing in order to be valid for a refund. There will be an administration fee for all cancellations with the remaining balance being refunded. Fees are as follows: Individual Camp $100, Shooting Camp $25, all other camps $50. Registration: Registration will take place at Coleman Coliseum. From registration campers will go to the dorm to move in. Emergencies: In case of an extreme emergency, please call (205) 348-4516 or (205) 348-5454.
GOTTFRIED’S CAMP
Individual Camp I: June 10-13 Individual Camp II: June 17-20 Participate in fundamental instruction while learning the basics including: working on your ball handling, passing, shooting, team play, and defense. Ages 9 - High School………………………..…$325 Sunday Check-in from 3-5 p.m. & Wednesday finish at 11:30 a.m. with an Award’s Ceremony. Day Camp: June 11-13 Learn the basic rules and fundamentals of the game through participation in many different basketball activities. Ages 5 - 12…………..………………………...…$105 8:30 - 11:30 a.m. Daily Shooting Camp I: June 13 Shooting Camp II: June 20 Fundamental instruction on the basics of shooting, from highly qualified instructors. Ages 5 - High School….………………………....$75 1 - 5 p.m.
BAMA Hoops, INC. BOX 870393 Tuscaloosa, AL 35487-0393
Parent Child Camp: June 8-9 A weekend camp for an adult and child to develop a bond through the sport of basketball. Instructions will be given to adults to assist in the teaching of drills for their children. Ages 5 - High School….….…………………….$205 Friday Check-in at 5 p.m. & Saturday finish at 5 p.m.
