2015 Camp Brochure
Camper’s Name:
(Policy Holder Name)
Policy Holder’s Social Security Number: -
Name and Address of Insurance Company:
Murray State University Racer Basketball
217 Stewart Stadium Murray, KY 42071
Parent’s Name:
-
2015 STEVE PROHM
1 100006 100105 x 5060
MEDICAL RELEASE FORM
Basketball Camps, LLC
Policy Number: Group Number: Any Other Identification:
Detach and Return
Insurance Co. Telephone:
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 Steve Prohm 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 Steve Prohm, 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 Steve Prohm. Murray State University, all other employees/agents of the camp from any and all liability from injuries. Please Note: A copy of Murray State University’s Annual Security Report can be obtained by contacting the Murray State Police Department at (270) 8092222 or by accessing the following website: www.murraystateuniversity.edu/ publicsafety/crime99.htm
Parent/Guardian Signature:
MINI CAMP AGES: 5-7 DATES: June 8-11 TIME: 9:00 a.m.-12:00 p.m. *NOTE: Campers who are 7 years old may be considered for youth camp at parent’s request.
YOUTH CAMP 1 AGE: 7-17 DATES: June 22-25 TIME: 9:00 am - 4:00 pm
Date:
YOUTH CAMP 2 AGE: 7-those entering 7th grade DATE: July 27-30. TIME: 9:00 am-4:00 pm Please note appropriate age for each camp per NCAA recruiting guidelines.
Our camp objective is to instruct young players in the fundamentals of the game, while instilling a love and appreciation for the game of basketball. We offer an experienced staff of instructors and a full schedule of activities. Each camper can count on an exciting and rewarding week of camp! Our Goal is to ensure that each camper receives outstanding personalized one-onone instruction to help them become a better player and a better person. I hope you will join us for a week of fun!
REGISTRATION FORM
MINI CAMP Name:
AGES: 5-7* COST: $90.00 DATES: June 8-11 TIME: 9:00 a.m.-12:00 p.m.
Address:
City, State, Zip:
YOUTH CAMP 1 Intended to provide a complete and in-depth basketball experience emphasizing fundamentals, team play. 7– year –olds may be considered for youth camp at parents’ request.
Age:
YOUTH CAMP 2
.
The age group for youth camp 2 will vary slightly from those Youth Campers Only: 1. Lunch can be purchased for $3.00 per camper. You may bring your lunch if you wish. 2. Youth camp begins at 9:00 am and will end at 4:00 pm each day. (Supervision will be provided from 8:00 am through 5:00 pm, Monday through Wednesday.) 3. Each camper will receive a camp t-shirt, ball, and certificate of completion. 4. Last day of “YOUTH CAMP” will end at NOON on THURSDAY.
S
M
L
XL
Adult Sizes
S
M
L
XL
(Circle One)
Parent/Guardian Information Name: Address:
City, State, Zip: Home Phone: Cell Phone: E-Mail:
Emergency Contact Information
James Kane
Name:
(270) 809-6730 or [email protected]
Phone:
Call the Men’s Basketball Office, at (270) 809-6804
You can also find more information about camps and Racer Basketball online at www.GoRacers.com
Female (Circle One)
Youth Sizes
ASSISTANT Men’s Basketball Coach,
OR
Male T-Shirt Size:
AGES: 7-17 COST: $180.00 DATES: June 22-25
AGES:7-those entering the 7th grade COST: $180.00 DATE: July 27-30 TIME: 9:00 a.m.– 4:00 p.m
FOR MORE INFORMATION
Camper Information
Designed to instill a love for the game and to teach basic fundamentals.
Detach and Return
A Word from COACH PROHM
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 checks payable to: Steve Prohm Basketball Camps, LLC
Please check all appropriate box(es) below:
MINI CAMP (ages 5-7*) June 8-11 Fee: $90 $45 deposit by 5/15
YOUTH CAMP (ages 7-17) June 22-25Fee: $180 $90 deposit due 6/1 _____July 27-30 Fee: $180 $90 deposit by 6/1
(Policy Holder Name)
Policy Holder’s Social Security Number: -
Name and Address of Insurance Company:
Murray State University Racer Basketball
217 Stewart Stadium Murray, KY 42071
Parent’s Name:
-
2015 STEVE PROHM
1 100006 100105 x 5060
MEDICAL RELEASE FORM
Basketball Camps, LLC
Policy Number: Group Number: Any Other Identification:
Detach and Return
Insurance Co. Telephone:
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 Steve Prohm 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 Steve Prohm, 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 Steve Prohm. Murray State University, all other employees/agents of the camp from any and all liability from injuries. Please Note: A copy of Murray State University’s Annual Security Report can be obtained by contacting the Murray State Police Department at (270) 8092222 or by accessing the following website: www.murraystateuniversity.edu/ publicsafety/crime99.htm
Parent/Guardian Signature:
MINI CAMP AGES: 5-7 DATES: June 8-11 TIME: 9:00 a.m.-12:00 p.m. *NOTE: Campers who are 7 years old may be considered for youth camp at parent’s request.
YOUTH CAMP 1 AGE: 7-17 DATES: June 22-25 TIME: 9:00 am - 4:00 pm
Date:
YOUTH CAMP 2 AGE: 7-those entering 7th grade DATE: July 27-30. TIME: 9:00 am-4:00 pm Please note appropriate age for each camp per NCAA recruiting guidelines.
Our camp objective is to instruct young players in the fundamentals of the game, while instilling a love and appreciation for the game of basketball. We offer an experienced staff of instructors and a full schedule of activities. Each camper can count on an exciting and rewarding week of camp! Our Goal is to ensure that each camper receives outstanding personalized one-onone instruction to help them become a better player and a better person. I hope you will join us for a week of fun!
REGISTRATION FORM
MINI CAMP Name:
AGES: 5-7* COST: $90.00 DATES: June 8-11 TIME: 9:00 a.m.-12:00 p.m.
Address:
City, State, Zip:
YOUTH CAMP 1 Intended to provide a complete and in-depth basketball experience emphasizing fundamentals, team play. 7– year –olds may be considered for youth camp at parents’ request.
Age:
YOUTH CAMP 2
.
The age group for youth camp 2 will vary slightly from those Youth Campers Only: 1. Lunch can be purchased for $3.00 per camper. You may bring your lunch if you wish. 2. Youth camp begins at 9:00 am and will end at 4:00 pm each day. (Supervision will be provided from 8:00 am through 5:00 pm, Monday through Wednesday.) 3. Each camper will receive a camp t-shirt, ball, and certificate of completion. 4. Last day of “YOUTH CAMP” will end at NOON on THURSDAY.
S
M
L
XL
Adult Sizes
S
M
L
XL
(Circle One)
Parent/Guardian Information Name: Address:
City, State, Zip: Home Phone: Cell Phone: E-Mail:
Emergency Contact Information
James Kane
Name:
(270) 809-6730 or [email protected]
Phone:
Call the Men’s Basketball Office, at (270) 809-6804
You can also find more information about camps and Racer Basketball online at www.GoRacers.com
Female (Circle One)
Youth Sizes
ASSISTANT Men’s Basketball Coach,
OR
Male T-Shirt Size:
AGES: 7-17 COST: $180.00 DATES: June 22-25
AGES:7-those entering the 7th grade COST: $180.00 DATE: July 27-30 TIME: 9:00 a.m.– 4:00 p.m
FOR MORE INFORMATION
Camper Information
Designed to instill a love for the game and to teach basic fundamentals.
Detach and Return
A Word from COACH PROHM
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 checks payable to: Steve Prohm Basketball Camps, LLC
Please check all appropriate box(es) below:
MINI CAMP (ages 5-7*) June 8-11 Fee: $90 $45 deposit by 5/15
YOUTH CAMP (ages 7-17) June 22-25Fee: $180 $90 deposit due 6/1 _____July 27-30 Fee: $180 $90 deposit by 6/1
