basketball camps
Minnesota State University Moorhead Department Of Intercollegiate Athletics Youth Programs Consent For Participation And Medical Information Day Camp and Shooting Camp Child’s Name ___________________________ Age ________
Meet the coaches
In case of emergency, contact __________________________ Emergency contact phone #____________________________ Medical Insurance Co.________________________________ Policy No. _____________________ Group No. ____________
CHAD WALTHALL Head Coach
Physician Name ___________________________________ Phone __________________________________________ Medical conditions the youth program staff and medical emergency services personnel need to be made aware of: ______________________________________________ ______________________________________________ I wish to register my minor child, ____________________ and consent to my child’s participation in the Summer Sports Camps and/ or Leagues sponsored by the Department of Intercollegiate Athletics of Minnesota State University Moorhead during the summer. I recognize that participation in recreational and instructional activities, even when well supervised and managed, pose a risk of physical injury to my child, and I agree to assume such a risk on behalf of my child. I understand that children registered for MSUM Athletics’ summer sport camps and/or leagues will receive instruction in the basic principles of sport(s) of their choice(s) and will spend a significant amount of time practicing and performing sporting techniques and/or researching and performing a variety of enrichment techniques under the supervision of experienced instructors, and I consent to my child’s participation in this program. I certify that my child has no medical condition or impairment, including the use of medication, that might inhibit his participation.
JUSTIN WIECK Assistant Coach
JORDAN RIEWER Assistant Coach
RELEASE OF LIABILITY I, the undersigned, hereby hold Minnesota State University Moorhead and the entire MSUM Dragon Athletics' Staff harmless from liability for any and all medical and/or accident expenses which my minor child may incur during his involvement in the Summer Sports camps and/ or leagues at the Department of Intercollegiate Athletics, MSUM. I hereby certify that my child is provided coverage via personal health and accident insurance in effect which is sufficient to cover any and all of the expenses, noted above, which might incur. Parent/Guardian Signature: ____________________________ Print Parent/Guardian Name:___________________________
JUNE 25-27 & JULY 23-24, 2018 Minnesota State University Moorhead is an equal opportunity educator and employer and is a member of the Minnesota State system. This information will be made available in alternate format, or if a disability-related accommodation is required, please contact Accessibility Resources at 218.477.4318 (voice) or 1.800.627.3529 (MRS/TYY).
BASKETBALL CAMPS
in a fun and competitive environment. Lunch is included in this 2-day opportunity to improve the most important skill in basketball.
(Checks payable to MSUM Boys Basketball Camps)
Adult: S M L XL
Send U.S. Funds Only to: MSUM Men’s Basketball Camp Alex Nemzek Hall 1104 7th Ave S Moorhead, MN 56563 $100
For more information contact contact Justin Wieck at 218-477-2316 or email [email protected]
A complete focus on the fundamentals of shooting
Dragon Shooting Camp (K-12th)
July 23-24, 2018 K-12th Grade | 9:00am – 4:00pm • $100 Includes Dragon T-Shirt & Lunch
□ July 23-24
Dragon Boys Basketball Shooting Camp
$50
will shift from drills to competition.
Dragon Competition Camp (K – 8th)
will be mixed with 1v1, 2v2, and 3v3 leagues. The focus
$50
atmosphere. Shooting, passing, dribbling competitions
□ June 25-27
▸ Walk-up registrations will be accepted
This unique setting will mix competition with a fun
Dragon Skills Camp (K-8th)
▸ $10 discount if signed up for both Skills & Competition Camp
June 25-27, 2018 K-8th Grade | 1:00pm – 4:00pm • $50 Includes Dragon T-Shirt
□ June 25-27
All check-in and camp activities will take place in Alex Nemzek Fieldhouse.
Dragon Boys Competition Camp
Please check desired camp:
LOCATION
one of a kind opportunity.
____________________________________________________________________________________
* Gym will be monitored between camps on June 25-27 for those who want to bring their own lunch
and former Dragon players & coaches. Don’t miss this
Please note any medical conditions that we should be aware of (attach an additional sheet if necessary)________________
A lunch will be provided for the Basketball Shooting Camp.
fun & encouraging environment. Learn from current
School_____________________________________ T-Shirt Size (circle): Youth: M L
Meals
A strong focus on the fundamentals of basketball in a
Camper’s Name__________________________________________________________________________
All campers must have medical insurance. You must complete the enrollment form on the reverse side of this page. By signing the form you acknowledge the inherent risk of injury by participation. Athletic training facilities are available during the camp and a certified athletic trainer will be on site at all times.
2018 MSUM BOYS’ Basketball Camps Registration Form
Insurance and Medical Treatment
June 25-27, 2018 K-8th Grade | 9:00am – 12:00pm • $50 Includes Dragon T-Shirt
Grade (Fall ‘15)________
Dragon Boys Skills Camp
Age_________Height__________ Position: □ Guard □ Forward □ Center
Register Online: mnstatetickets.universitytickets.com
Phone (Home)__________________________Email____________________________
Schedule and pricing
Address______________________________City_________________ State________ Zip________________
ONLINE REGISTRATION
Meet the coaches
In case of emergency, contact __________________________ Emergency contact phone #____________________________ Medical Insurance Co.________________________________ Policy No. _____________________ Group No. ____________
CHAD WALTHALL Head Coach
Physician Name ___________________________________ Phone __________________________________________ Medical conditions the youth program staff and medical emergency services personnel need to be made aware of: ______________________________________________ ______________________________________________ I wish to register my minor child, ____________________ and consent to my child’s participation in the Summer Sports Camps and/ or Leagues sponsored by the Department of Intercollegiate Athletics of Minnesota State University Moorhead during the summer. I recognize that participation in recreational and instructional activities, even when well supervised and managed, pose a risk of physical injury to my child, and I agree to assume such a risk on behalf of my child. I understand that children registered for MSUM Athletics’ summer sport camps and/or leagues will receive instruction in the basic principles of sport(s) of their choice(s) and will spend a significant amount of time practicing and performing sporting techniques and/or researching and performing a variety of enrichment techniques under the supervision of experienced instructors, and I consent to my child’s participation in this program. I certify that my child has no medical condition or impairment, including the use of medication, that might inhibit his participation.
JUSTIN WIECK Assistant Coach
JORDAN RIEWER Assistant Coach
RELEASE OF LIABILITY I, the undersigned, hereby hold Minnesota State University Moorhead and the entire MSUM Dragon Athletics' Staff harmless from liability for any and all medical and/or accident expenses which my minor child may incur during his involvement in the Summer Sports camps and/ or leagues at the Department of Intercollegiate Athletics, MSUM. I hereby certify that my child is provided coverage via personal health and accident insurance in effect which is sufficient to cover any and all of the expenses, noted above, which might incur. Parent/Guardian Signature: ____________________________ Print Parent/Guardian Name:___________________________
JUNE 25-27 & JULY 23-24, 2018 Minnesota State University Moorhead is an equal opportunity educator and employer and is a member of the Minnesota State system. This information will be made available in alternate format, or if a disability-related accommodation is required, please contact Accessibility Resources at 218.477.4318 (voice) or 1.800.627.3529 (MRS/TYY).
BASKETBALL CAMPS
in a fun and competitive environment. Lunch is included in this 2-day opportunity to improve the most important skill in basketball.
(Checks payable to MSUM Boys Basketball Camps)
Adult: S M L XL
Send U.S. Funds Only to: MSUM Men’s Basketball Camp Alex Nemzek Hall 1104 7th Ave S Moorhead, MN 56563 $100
For more information contact contact Justin Wieck at 218-477-2316 or email [email protected]
A complete focus on the fundamentals of shooting
Dragon Shooting Camp (K-12th)
July 23-24, 2018 K-12th Grade | 9:00am – 4:00pm • $100 Includes Dragon T-Shirt & Lunch
□ July 23-24
Dragon Boys Basketball Shooting Camp
$50
will shift from drills to competition.
Dragon Competition Camp (K – 8th)
will be mixed with 1v1, 2v2, and 3v3 leagues. The focus
$50
atmosphere. Shooting, passing, dribbling competitions
□ June 25-27
▸ Walk-up registrations will be accepted
This unique setting will mix competition with a fun
Dragon Skills Camp (K-8th)
▸ $10 discount if signed up for both Skills & Competition Camp
June 25-27, 2018 K-8th Grade | 1:00pm – 4:00pm • $50 Includes Dragon T-Shirt
□ June 25-27
All check-in and camp activities will take place in Alex Nemzek Fieldhouse.
Dragon Boys Competition Camp
Please check desired camp:
LOCATION
one of a kind opportunity.
____________________________________________________________________________________
* Gym will be monitored between camps on June 25-27 for those who want to bring their own lunch
and former Dragon players & coaches. Don’t miss this
Please note any medical conditions that we should be aware of (attach an additional sheet if necessary)________________
A lunch will be provided for the Basketball Shooting Camp.
fun & encouraging environment. Learn from current
School_____________________________________ T-Shirt Size (circle): Youth: M L
Meals
A strong focus on the fundamentals of basketball in a
Camper’s Name__________________________________________________________________________
All campers must have medical insurance. You must complete the enrollment form on the reverse side of this page. By signing the form you acknowledge the inherent risk of injury by participation. Athletic training facilities are available during the camp and a certified athletic trainer will be on site at all times.
2018 MSUM BOYS’ Basketball Camps Registration Form
Insurance and Medical Treatment
June 25-27, 2018 K-8th Grade | 9:00am – 12:00pm • $50 Includes Dragon T-Shirt
Grade (Fall ‘15)________
Dragon Boys Skills Camp
Age_________Height__________ Position: □ Guard □ Forward □ Center
Register Online: mnstatetickets.universitytickets.com
Phone (Home)__________________________Email____________________________
Schedule and pricing
Address______________________________City_________________ State________ Zip________________
ONLINE REGISTRATION
