Day Camp I June 26-29 Day Camp II July 10-13 2017 Boys ...
Camp Registration Form
Camp Director
Name ________________________________________ Address ______________________________________ City __________________ State _____ Zip__________ Telephone (H)_ ________________ (w) ____________ Age ____
Gender_____ Grade in Fall 2017_____ Height____
Parent(s) Name(s) ______________________________ Parent Contact Number (c) ________________________
Tim Fusina completed his fourth season as head coach of the Centenary University men's basketball team in 2016-2017.
School Attending in Fall 2017______________________ AAU Team ____________________________________
Fusina's teams at Centenary have set records that the program has never achieved. They have set the program record for wins, highest conference finish and back to back post-season appearances.
T-Shirt Size (Adult Sizes) ________________________ Please check the camp(s) you will be attending: ____June 26-29 Day Camp I ____July 10-13 Day Camp II ***Discounts do not apply for students in grades 9-12*** Parent’s Signature ___________________________
_
Email Address:_______________________________ Deposit: $50.00 *Please make checks payable to: Centenary University Deposit is non-refundable Please return application & other fees to: Centenary University Basketball Camp 400 Jefferson Street Hackettstown, NJ 07840 *FINAL PAYMENT MUST BE CHECK, OR CASH.
From 2008-2013, Fusina served as the assistant men’s basketball coach at Washington & Jefferson College. He helped guide W & J to one of the most successful periods in program history as the Presidents claimed the 2009 ECAC South Region championship and earned 20 victories for just the second time in team history during his tenure. Under Fusina’s tutelage, five of his players garnered all-conference accolades. Fusina is a member of the National Association of Collegiate Basketball Coaches (NABC). In addition to his collegiate coaching experience, he has also served as an instructor at numerous summer basketball camps.
2017 Boys & Girls Basketball Camp Day Camp I June 26-29 Day Camp II July 10-13
Coaches and players of the Cyclone Basketball teams along with other experienced high school and college coaches will make up an energetic staff that will be sure to provide instruction that is second to none and an experience that your child will always remember.
2017 BASKETBALL CAMPS DAY CAMP I Monday June 26—Thursday June 29 9am—3pm $200
MEDICAL RELEASE FORM
Camp begins each day at 9am sharp and ends promptly at 3pm—it is important that camp begins on time in order to complete an extensive daily schedule. It is also imperative that campers are picked up in a timely fashion once the camp day ends.
I herby give permission for _______________________to participate in the 2017 Centenary University Basketball Camp. I certify that my son/daughter is in good physical condition, has been examined within the last 12 months and no medical reason has been found that he cannot participate in this camp. Records show that all immunizations are up to date. I understand that he/she will be participating in rigorous play and activity. Centenary University Personnel have also been informed of any physical limitations, medications or prior conditions. The camp will safeguard the health of my child but will not be responsible for accidents, injuries or sickness on the way to camp, during camp or on the way home.
Campers may arrive at 8:30 am to shoot around
Campers are responsible for bringing their own lunch each day to camp. Lunch will NOT be provided.
Each Camper will receive a T-shirt
There will be a Camp Store where campers can purchase drinks, snacks and apparel throughout the day during breaks.
Throughout the week there will be awards for Camper of the Day and Camper of the week award will be issued on the last day.
There will be fun within a framework of discipline in a positive, encouraging environment for your child to excel. Call: Tim Fusina, Head Basketball Coach at 908-852-1400 ext. 2199 or e-mail at [email protected]
Detach Here
The Cyclone Basketball Camp is designed for boys and girls between the ages of 7—15 years old. Camp will be held in the Gymnasium at the Reeves Student Recreation Center on the Centenary University campus.
General Camp Information
I agree that in the case of an accident involving my child while attending camp, and with full awareness that basketball is an activity that may involve risk or injury, I release Centenary University and the staff of Centenary University Basketball Camp from any and all liability. I hereby request that my child be granted admittance into the 2017 Centenary University Basketball Camp and authorize the directors to act on my behalf in the event of an emergency requiring medical attention. I will assume responsibility for payment for any such attention and have provided current insurance information as requested. Camper Name __________________________Age_____ Parent(s) Name(s) ______________________________ Parent(s) Daytime Phone ________________________ Home Phone ____________________________________
Emergency Contact ______________________________ Relationship __________Contact Phone# ____________
DAY CAMP II Monday July 10—Thursday July 13 9am – 3pm $200 *Centenary employees ask about the camp discount.*
Insurance Carrier_______________________________ Policy #_______________________________________ Previous Medical Conditions _______________________ By Signing below, I agree to all the terms detailed above
www.centenarycyclones.com
Parent/Guardian Signature _________________________
Camp Director
Name ________________________________________ Address ______________________________________ City __________________ State _____ Zip__________ Telephone (H)_ ________________ (w) ____________ Age ____
Gender_____ Grade in Fall 2017_____ Height____
Parent(s) Name(s) ______________________________ Parent Contact Number (c) ________________________
Tim Fusina completed his fourth season as head coach of the Centenary University men's basketball team in 2016-2017.
School Attending in Fall 2017______________________ AAU Team ____________________________________
Fusina's teams at Centenary have set records that the program has never achieved. They have set the program record for wins, highest conference finish and back to back post-season appearances.
T-Shirt Size (Adult Sizes) ________________________ Please check the camp(s) you will be attending: ____June 26-29 Day Camp I ____July 10-13 Day Camp II ***Discounts do not apply for students in grades 9-12*** Parent’s Signature ___________________________
_
Email Address:_______________________________ Deposit: $50.00 *Please make checks payable to: Centenary University Deposit is non-refundable Please return application & other fees to: Centenary University Basketball Camp 400 Jefferson Street Hackettstown, NJ 07840 *FINAL PAYMENT MUST BE CHECK, OR CASH.
From 2008-2013, Fusina served as the assistant men’s basketball coach at Washington & Jefferson College. He helped guide W & J to one of the most successful periods in program history as the Presidents claimed the 2009 ECAC South Region championship and earned 20 victories for just the second time in team history during his tenure. Under Fusina’s tutelage, five of his players garnered all-conference accolades. Fusina is a member of the National Association of Collegiate Basketball Coaches (NABC). In addition to his collegiate coaching experience, he has also served as an instructor at numerous summer basketball camps.
2017 Boys & Girls Basketball Camp Day Camp I June 26-29 Day Camp II July 10-13
Coaches and players of the Cyclone Basketball teams along with other experienced high school and college coaches will make up an energetic staff that will be sure to provide instruction that is second to none and an experience that your child will always remember.
2017 BASKETBALL CAMPS DAY CAMP I Monday June 26—Thursday June 29 9am—3pm $200
MEDICAL RELEASE FORM
Camp begins each day at 9am sharp and ends promptly at 3pm—it is important that camp begins on time in order to complete an extensive daily schedule. It is also imperative that campers are picked up in a timely fashion once the camp day ends.
I herby give permission for _______________________to participate in the 2017 Centenary University Basketball Camp. I certify that my son/daughter is in good physical condition, has been examined within the last 12 months and no medical reason has been found that he cannot participate in this camp. Records show that all immunizations are up to date. I understand that he/she will be participating in rigorous play and activity. Centenary University Personnel have also been informed of any physical limitations, medications or prior conditions. The camp will safeguard the health of my child but will not be responsible for accidents, injuries or sickness on the way to camp, during camp or on the way home.
Campers may arrive at 8:30 am to shoot around
Campers are responsible for bringing their own lunch each day to camp. Lunch will NOT be provided.
Each Camper will receive a T-shirt
There will be a Camp Store where campers can purchase drinks, snacks and apparel throughout the day during breaks.
Throughout the week there will be awards for Camper of the Day and Camper of the week award will be issued on the last day.
There will be fun within a framework of discipline in a positive, encouraging environment for your child to excel. Call: Tim Fusina, Head Basketball Coach at 908-852-1400 ext. 2199 or e-mail at [email protected]
Detach Here
The Cyclone Basketball Camp is designed for boys and girls between the ages of 7—15 years old. Camp will be held in the Gymnasium at the Reeves Student Recreation Center on the Centenary University campus.
General Camp Information
I agree that in the case of an accident involving my child while attending camp, and with full awareness that basketball is an activity that may involve risk or injury, I release Centenary University and the staff of Centenary University Basketball Camp from any and all liability. I hereby request that my child be granted admittance into the 2017 Centenary University Basketball Camp and authorize the directors to act on my behalf in the event of an emergency requiring medical attention. I will assume responsibility for payment for any such attention and have provided current insurance information as requested. Camper Name __________________________Age_____ Parent(s) Name(s) ______________________________ Parent(s) Daytime Phone ________________________ Home Phone ____________________________________
Emergency Contact ______________________________ Relationship __________Contact Phone# ____________
DAY CAMP II Monday July 10—Thursday July 13 9am – 3pm $200 *Centenary employees ask about the camp discount.*
Insurance Carrier_______________________________ Policy #_______________________________________ Previous Medical Conditions _______________________ By Signing below, I agree to all the terms detailed above
www.centenarycyclones.com
Parent/Guardian Signature _________________________
