Elite Camp I
RELEASE OF LIABILITY & AUTHORIZATION FOR MEDICAL TREATMENT
Camp is not sponsored or operated by Eastern Kentucky University.
Insurance Company: ______________________________ Insurance Policy #: _______________________________ Any and all restrictions, medical conditions, allergies or medications applicable to Child: ________________________________________________ I have fully read and agree to the terms of this Release and Authorization for Medical Treatment. Parent/Guardian Signature:_______________________________________ Printed Name:___________________________________ Date:__________________________________________ First Emergency Contact Name:_________________________________________ Home Phone #:__________________________________ Work Phone #:__________________________________ Second Emergency Contact Name:_________________________________________
@ EASTERN KENTUCKY UNIVERSITY CHRISSY ROBERTS BASKETBALL CAMPS Eastern Kentucky University 115 Alumni Coliseum 521 Lancaster Avenue Richmond, Kentucky 40475
I hereby request that you accept this application for the Chrissy Roberts Basketball Camp and allow my child, ________________________________ (“Child”), to participate in the Camp during the dates set forth in this application and for which I have applied. I recognize that there are dangers, risks and possible injuries to Child which are inherent in and may result from participation in Camp activities. In consideration of your acceptance of this application and allowing Child to participate in the Camp, I hereby release Chrissy Roberts Basketball Camp (“Camp Sponsor”), authorized Camp personnel, Eastern Kentucky University, including its regents and employees, from any liability, cost or damages should any injury or illness occur to my child while participating in the Camp or which may in any way arise from or relate to the Camp, including serious injury or even death. I have instructed Child to obey all rules, regulations and instructions of the Camp Sponsor, including all authorized Camp personnel, in an effort to help minimize such risk. Child is in good physical health and fitness to allow him to participate in the Camp. In the event of possible injury, I give permission for the administration of emergency medical care to Child. I agree to be responsible for all costs which may be associated with medical care provided to Child. Below is the applicable and accurate medical and insurance information for Child:
Elite Camp I - June 12 Team Camp - June 12-15 Individual Camp - June 17-19 Elite Camp II - August 9
Elite Camp I: June 12 (Open to any and all participants Grades 6-12) On October 12, 2007, Chrissy Roberts returned to her alma mater to be inducted into the school’s Athletics Hall of Fame. Seven months later, Roberts returned to EKU again, this time for a longer stay. Roberts was selected as the program’s eighth head coach on May 29, 2008. During the 2012-2013 season Roberts led the Lady Colonels to 18 overall wins, the most wins at EKU since the 2004-2005 season. In 2011-12, EKU more than doubled its number of wins from the previous season. Roberts led the Lady Colonels to a 7-win improvement, which tied for the seventh best turnaround in the nation a year ago. Eastern finished four spots higher than it was picked in the preseason OVC poll. The Eminence, KY native is one of the most decorated players in the history of Eastern Kentucky University Women’s Basketball. During her Senior campaign, she was selected as the OVC Player of the Year, earned first team all-conference honors for the second straight season and garnered Kodak All-America Honorable Mention honors. She helped the Lady Colonels (20-8, 15-3 OVC) to their second straight OVC regular-season title. On her way to earning OVC Player of the Year honors, Roberts ranked in the top-10 in the OVC in nine different categories. Roberts holds school records for three-pointers in a single season (85 in 1996-97) and career three-point field goal percentage (47.6). She is fifth on Eastern’s career three-pointers made list (152). Coach Roberts will be assisted by her entire coaching staff at camp. Melissa Kolbe, Kent Miller, Brett Rector, and Colette Cole. Members of the Lady Colonels will also be on hand to help teach and coach the campers. WHAT OTHERS ARE SAYING ABOUT CHRISSY ROBERTS… “Chrissy Roberts is an excellent hire for EKU. Anytime you go back to your alma mater is a special time. She has the complete package and is ready to be a head coach. Chrissy is going to do a great job and I am excited for her and looking forward to her success. She has been a really huge part of our success over the past six years and will be really hard to replace.” Sharon Baldwin-Tenner, Former Head Coach, East Carolina University “I’m very excited for Chrissy. I’ve know her for several years and EKU is getting a great person and coach to lead their program. I’ve seen her work hard and she’s a great recruiter. There is no doubt in my mind that she’ll have success at EKU.” Mike Carey, Head Coach, West Virginia University
$65 per player / $50 per player if Application & Payment are received by June 1, 2013 Each camper will receive a camp t-shirt Individual instruction on skill development Registration: 10:45 - 11:45 AM (Alumni Coliseum) Camp begins at 12:00 PM and conclude by 4:00 PM NCAA rules session
Team Camp: June 12-15 (Open to all High School Varsity and JV teams)
$100 Team Fee / $165 per player $100 Team Fee / $85 per player (Commuter teams) Teams will be housed in the dormitories on campus Lunch & Dinner provided in the Powell building (2 Meals Thurs. & Fri., Lunch on Sat.) $100 Team fee must be paid by June 1, 2013 to reserve a spot in camp. Registration: 5:00-6:00 PM (Alumni Coliseum) Highlights…Individual instruction, NCAA rules session, Talent Show
Individual Camp: June 17-19 (Open to any and all participants Age 7-16)
$65 per player / $50 per player if Application & Payment are received by June 3, 2013 Registration: 7:45-8:45 AM (Alumni Coliseum) Camp will begin at 9 AM and end at 12:30 PM daily Each camper will receive a camp t-shirt
Elite Camp II: August 9 (Open to any and all participants Grades 6-12)
$65 per player / $50 per player if Application & Payment are received by June 1, 2013 Each camper will receive a camp t-shirt Individual instruction on skill development Registration: 10:45 - 11:45 AM (Alumni Coliseum) Camp begins at 12:00 PM and conclude by 4:00 PM NCAA rules session
NAME ___________________________________________________ HOME ADDRESS __________________________________________ CITY _________________________ STATE ________ ZIP _________ HOME PHONE (include area code) ____________________________ AGE _________ DATE OF BIRTH _______________ GRADE ________ HEIGHT ____________________ WEIGHT _____________________ EMAIL ___________________________________________________ PARENTS NAMES __________________________________________ SCHOOL _________________________________________________ T-SHIRT SIZE: (ADULT S, M, L, XL) ____________________________ T-SHIRT SIZE: (YOUTH S, M, L, XL) ____________________________ I WISH TO ENROLL IN THE FOLLOWING SESIONS: _______
JUNE 12 - ELITE CAMP
_______
JUNE 12-15 - TEAM CAMP
_______
JUNE 17-19 - INDIVIDUAL CAMP
_______
AUGUST 9 - ELITE CAMP
Payment Information: Send check or money order payable to: CHRISSY ROBERTS BASKETBALL CAMP Eastern Kentucky University Alumni Coliseum 115 521 Lancaster Avenue Richmond, KY 40475 For more camp information, contact Colette Cole, Director of Basketball Operations (859) 625-2591 or [email protected]
Camp is not sponsored or operated by Eastern Kentucky University.
Insurance Company: ______________________________ Insurance Policy #: _______________________________ Any and all restrictions, medical conditions, allergies or medications applicable to Child: ________________________________________________ I have fully read and agree to the terms of this Release and Authorization for Medical Treatment. Parent/Guardian Signature:_______________________________________ Printed Name:___________________________________ Date:__________________________________________ First Emergency Contact Name:_________________________________________ Home Phone #:__________________________________ Work Phone #:__________________________________ Second Emergency Contact Name:_________________________________________
@ EASTERN KENTUCKY UNIVERSITY CHRISSY ROBERTS BASKETBALL CAMPS Eastern Kentucky University 115 Alumni Coliseum 521 Lancaster Avenue Richmond, Kentucky 40475
I hereby request that you accept this application for the Chrissy Roberts Basketball Camp and allow my child, ________________________________ (“Child”), to participate in the Camp during the dates set forth in this application and for which I have applied. I recognize that there are dangers, risks and possible injuries to Child which are inherent in and may result from participation in Camp activities. In consideration of your acceptance of this application and allowing Child to participate in the Camp, I hereby release Chrissy Roberts Basketball Camp (“Camp Sponsor”), authorized Camp personnel, Eastern Kentucky University, including its regents and employees, from any liability, cost or damages should any injury or illness occur to my child while participating in the Camp or which may in any way arise from or relate to the Camp, including serious injury or even death. I have instructed Child to obey all rules, regulations and instructions of the Camp Sponsor, including all authorized Camp personnel, in an effort to help minimize such risk. Child is in good physical health and fitness to allow him to participate in the Camp. In the event of possible injury, I give permission for the administration of emergency medical care to Child. I agree to be responsible for all costs which may be associated with medical care provided to Child. Below is the applicable and accurate medical and insurance information for Child:
Elite Camp I - June 12 Team Camp - June 12-15 Individual Camp - June 17-19 Elite Camp II - August 9
Elite Camp I: June 12 (Open to any and all participants Grades 6-12) On October 12, 2007, Chrissy Roberts returned to her alma mater to be inducted into the school’s Athletics Hall of Fame. Seven months later, Roberts returned to EKU again, this time for a longer stay. Roberts was selected as the program’s eighth head coach on May 29, 2008. During the 2012-2013 season Roberts led the Lady Colonels to 18 overall wins, the most wins at EKU since the 2004-2005 season. In 2011-12, EKU more than doubled its number of wins from the previous season. Roberts led the Lady Colonels to a 7-win improvement, which tied for the seventh best turnaround in the nation a year ago. Eastern finished four spots higher than it was picked in the preseason OVC poll. The Eminence, KY native is one of the most decorated players in the history of Eastern Kentucky University Women’s Basketball. During her Senior campaign, she was selected as the OVC Player of the Year, earned first team all-conference honors for the second straight season and garnered Kodak All-America Honorable Mention honors. She helped the Lady Colonels (20-8, 15-3 OVC) to their second straight OVC regular-season title. On her way to earning OVC Player of the Year honors, Roberts ranked in the top-10 in the OVC in nine different categories. Roberts holds school records for three-pointers in a single season (85 in 1996-97) and career three-point field goal percentage (47.6). She is fifth on Eastern’s career three-pointers made list (152). Coach Roberts will be assisted by her entire coaching staff at camp. Melissa Kolbe, Kent Miller, Brett Rector, and Colette Cole. Members of the Lady Colonels will also be on hand to help teach and coach the campers. WHAT OTHERS ARE SAYING ABOUT CHRISSY ROBERTS… “Chrissy Roberts is an excellent hire for EKU. Anytime you go back to your alma mater is a special time. She has the complete package and is ready to be a head coach. Chrissy is going to do a great job and I am excited for her and looking forward to her success. She has been a really huge part of our success over the past six years and will be really hard to replace.” Sharon Baldwin-Tenner, Former Head Coach, East Carolina University “I’m very excited for Chrissy. I’ve know her for several years and EKU is getting a great person and coach to lead their program. I’ve seen her work hard and she’s a great recruiter. There is no doubt in my mind that she’ll have success at EKU.” Mike Carey, Head Coach, West Virginia University
$65 per player / $50 per player if Application & Payment are received by June 1, 2013 Each camper will receive a camp t-shirt Individual instruction on skill development Registration: 10:45 - 11:45 AM (Alumni Coliseum) Camp begins at 12:00 PM and conclude by 4:00 PM NCAA rules session
Team Camp: June 12-15 (Open to all High School Varsity and JV teams)
$100 Team Fee / $165 per player $100 Team Fee / $85 per player (Commuter teams) Teams will be housed in the dormitories on campus Lunch & Dinner provided in the Powell building (2 Meals Thurs. & Fri., Lunch on Sat.) $100 Team fee must be paid by June 1, 2013 to reserve a spot in camp. Registration: 5:00-6:00 PM (Alumni Coliseum) Highlights…Individual instruction, NCAA rules session, Talent Show
Individual Camp: June 17-19 (Open to any and all participants Age 7-16)
$65 per player / $50 per player if Application & Payment are received by June 3, 2013 Registration: 7:45-8:45 AM (Alumni Coliseum) Camp will begin at 9 AM and end at 12:30 PM daily Each camper will receive a camp t-shirt
Elite Camp II: August 9 (Open to any and all participants Grades 6-12)
$65 per player / $50 per player if Application & Payment are received by June 1, 2013 Each camper will receive a camp t-shirt Individual instruction on skill development Registration: 10:45 - 11:45 AM (Alumni Coliseum) Camp begins at 12:00 PM and conclude by 4:00 PM NCAA rules session
NAME ___________________________________________________ HOME ADDRESS __________________________________________ CITY _________________________ STATE ________ ZIP _________ HOME PHONE (include area code) ____________________________ AGE _________ DATE OF BIRTH _______________ GRADE ________ HEIGHT ____________________ WEIGHT _____________________ EMAIL ___________________________________________________ PARENTS NAMES __________________________________________ SCHOOL _________________________________________________ T-SHIRT SIZE: (ADULT S, M, L, XL) ____________________________ T-SHIRT SIZE: (YOUTH S, M, L, XL) ____________________________ I WISH TO ENROLL IN THE FOLLOWING SESIONS: _______
JUNE 12 - ELITE CAMP
_______
JUNE 12-15 - TEAM CAMP
_______
JUNE 17-19 - INDIVIDUAL CAMP
_______
AUGUST 9 - ELITE CAMP
Payment Information: Send check or money order payable to: CHRISSY ROBERTS BASKETBALL CAMP Eastern Kentucky University Alumni Coliseum 115 521 Lancaster Avenue Richmond, KY 40475 For more camp information, contact Colette Cole, Director of Basketball Operations (859) 625-2591 or [email protected]
