Minnesota State University Moorhead Department Of Intercollegiate Athletics Youth Programs Consent For Participation And Medical Information Regular Session and Position Camp Child’s Name ___________________________ Age ________
Meet the coaches
In case of emergency, contact __________________________ Emergency contact phone #____________________________ Medical Insurance Co.________________________________ Policy No. _____________________ Group No. ____________ 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.
Karla Nelson Head Coach ▶ Coach Nelson is the winningest
coach in MSUM history and the only coach to surpass 300 wins ▶ 17 straight winning seasons ▶ 3-time NSIC Coach of the Year ▶ 2016 & 2017 NSIC North Division Champions ▶ 2005 & 2017 NSIC Regular Season Champions ▶ 2005, 2007, 2009, 2017 NCAA Tournament Participants ▶ Coached 35 All-NSIC players & 1 NSIC Player of the Year ▶ Coached 5 NCAA All-Region players including 2 All-Americans
Allison Swenson 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.
Summer 2017
Parent/Guardian Signature: ____________________________ Print Parent/Guardian Name:___________________________ Minnesota State University Moorhead is an equal opportunity educator and employer and is a member of the Minnesota State system.
Girl's BASKETBALL CAMPS
Dragon Team Camps SESSION I: Thursday, June 8
fundamentals through drills & completion.
2017 MSUM girls’ Basketball Camps Registration Form
fundamental skills.
Team/Camper’s Name_____________________________
7TH–8TH GRADE SKILLS CAMP CONT. ▶ Camp will allow players to improve their
Price: $250 per team (3 game guarantee)
▶ Camp will focus on both offensive & defensive
SESSION II: Friday, June 16
▶ Campers will be taught by current Dragon players
Price: $250 per team (3 game guarantee)
SESSION III: Friday, June 23
and coaches. ▶ Each camper will receive a camp t-shirt & basketball.
Price: $250 per team (3 game guarantee)
HIGH SCHOOL ELITE CAMP
SESSION IV: Thurs–Fri, July 13–14
Saturday, June 24 (Entering Grades 9–12) Camp Check-In: 12:00–12:30 PM Camp Times: 12:30–5:00 PM Price $90
Price: $350 per team (5 game guarantee) ▶ Varsity & JV divisions at all sessions
Individual Camps
▶ This camp is for players looking to compete at the
4TH–6TH GRADE SKILLS CAMP
experiences similar to what our players see on a daily basis with practice and preparation to compete at the college level. ▶ Each camper will receive a camp t-shirt & snacks throughout camp.
June 19–22 Camp Check-In: June 19 | 8:00–9:00 AM Camp Times: Mon–Thurs | 9:00 AM–12:30 PM Price: $160 July 10–12 Camp Check-In: July 10 | 8:00–9:00 AM Camp Times: Mon–Wed | 9:00 AM–12:30 PM Price: $120 ▶ Camp will allow players to improve their
fundamentals through drills & completion.
▶ Camp will focus on both offensive & defensive
fundamental skills.
▶ Campers will be taught by current Dragon players
and coaches. ▶ Each camper will receive a camp t-shirt & basketball.
next level.
▶ Camp will focus on providing Elite players with
JUNIOR DRAGONS CAMP July 28–29 (Entering Grades K-3) Camp Check-In: July 28 | 8:00–9:00 AM Camp Times: Fri–Sat | 9:00 AM–Noon Price: 1 day rate: $30 | 2 day rate: $60
▶ Campers will learn the basic skills of basketball while
having fun. ▶ This camp will focus on passing, dribbling, and proper shooting techniques. ▶ Each camper will receive a camp t-shirt & basketball.
7TH–8TH GRADE SKILLS CAMP
CANCELLATION POLICY
June 19–22 Camp Check-In: June 19 | 12:30–1:30 PM Camp Times: Mon–Thurs | 1:30–5:00 PM Price $160
Day Campers: A $30 non-refundable deposit is required with your registration. The remaining balance is due upon check-in on the first day of camp.
July 10–12 Camp Check-In: July 10 | 12:30–1:30 PM Camp Times: Mon–Wed | 1:30–5:00 PM Price: $120
Team Camp: A $100 non-refundable deposit is required with EACH team’s registration. Any remaining balance is due upon check-in on the first day of camp. If cancellation occurs after the schedule has been released, no refund of any kind will be made.
Address______________________________________ City_________________________________________ State________________________________________ Zip_________________________________________ Phone (Home)__________________________________ Email _______________________________________ Age ______ Height_______ Grade (Fall ‘17) ____________ _Position:
□ Guard
□ Forward
□ Center
School ______________________________________ T-Shirt Size (circle): Youth: M L
Adult: S M L XL
Please note any medical conditions that we should be aware of (attach an additional sheet if necessary) ________________ ___________________________________________ Please check desired camp: □ June 8 □ June 16 □ June 23 □ July 13-14
□Varsity □JV
Team Camp Session I
$250
Team Camp Session II
$250 □Varsity □JV
Team Camp Session III
$250
Team Camp Session IV
$350 □Varsity □JV
□ June 19-22 □ July 10-12 □ June 19-22 □ July 10-12
4th–6th Grade Skills Camp
$160
4th–6th Grade Skills Camp
$120
7th–8th Grade Skills Camp
$160
7th–8th Grade Skills Camp
$120
□ June 24
High School Elite Camp
$90
□ July 28-29
Junior Dragons Camp
□Varsity □JV
□$30
□$60
Or register online at msumdragons.com/camps Send U.S. Funds Only to: MSUM Women’s Basketball Allison Swenson-Camp Coordinator 1104 7th Ave S Moorhead, MN 56563 (Checks payable to Dragon BB Camp) For more information contact Allison Swenson at 218-477-2888 or email at
[email protected] OR Karla Nelson at 218.477.2421 or email at
[email protected]