JUNE 26 - 28, 2017
MEDICAL TREATMENT RELEASE
This form must be filled out before registration is complete.
Fleming Hall P.O. Box 1000 Institute, WV 25112
It is the responsibility of the camper’s parent or guardian to ensure that the camper is healthy and has no physical problem that would prevent her participation in all camp activities.
Camper’s Name: _________________________________________ Last
First
Middle
Date of last Tetanus Immunization:
JUNE 26 - 28, 2017 5 - 8 P.M.
_________________________________________ (MM/DD/YYYY)
List any allergies to medication: _________________________________________ _________________________________________ Please list any condition that the camp directors should know about: __________________________ _________________________________________ Emergency Phone Numbers: Day: ______________________________________ Nights: ____________________________________ I authorize any medical treatment that might be advised by physicians available to the Basketball Camp while my daughter is present at the camp. Parent or Guardian Signature: _________________________________________ Date Company Name: ____________________________ Policy Number: _____________________________ Name the Policy is under: _____________________
Place Stamp Here
MEDICAL INSURANCE INFORMATION
REGISTRATION FORM: (please fill in all sections – print with INK only)
INTRODUCTION: Coach Charles Marshall and his basketball teams have a long history of excellence. During the past 5 seasons, Marshall’s teams have lead the nation in scoring, averaging just under 100 points per game. His teams have also lead the nation in 3 point shots made per game with 11 or more. During the 2013-2014 Season Marshall led his team through an “Undisputed!” year. Capturing both the MEC Regular Season Championship and the MEC Tournament Championship, in its initial year. His Team ranked #1 in the Atlantic Region which allowed them to host the first round of game for the NCAA National Tournament. In his short coaching career Marshall’s teams have captured 2 regular season championships as well as 2 tournament championships. In Just first year at State, Coach Marshall lead his team in setting a school record for most points scored in a game with 123pts. Marshall’s teams have a long history of being exciting, fast paced, high scoring, and Championship Winning. Now he wants to host a camp for young girls who want to become part of his winning tradition.
ENROLLMENT: Since enrollment is limited, registration is encouraged as soon as possible, but no later Tuesday, June 20th. Please enclose your $50 deposit with the registration materials. Refund of deposit cannot be made Monday June 12th as monies will already be committed.
PURPOSE: This year’s individual camp will provide unique opportunities for campers to participate in skills sessions and drill work that Coach Marshall’s team uses. The focus will be on improving each camper’s abilities in all aspects of the game.
Camper’s Name: ____________________________
LOCATION: The camp will be located on the campus of West Virginia State University in Institute, WV. The college is located off exit 50 on I-64. Camp activities will be conducted in the Walker Convocation Center.
Age: ______________________________________
FEES:
City: ______________________ State: ___________
The camp cost will cover: camp instruction, basketball, prizes, travel, and a certificate of participation. *Individual Skills Day Camp Fee: $45/camper.
Zip Code:__________________________________
WHAT TO BRING:
Cell Phone:_________________________________
Campers should bring the following items: basketball shoes, water bottle, packed lunches or spending money (food and drinks will be available at Concession Stand.), *bathing suit & towel on specified days.
CAMP FEATURES: • Passing • Form shooting • Ball handling • 3 point shooting • Defense • How to improve at the • Footwork free throw line There will be a 1 on 1 league, 3 on 3 league, and a 5 on 5 league, in which games will be played every day. There will also be a free throw shooting contest, and skills competitions throughout camp. There will be prizes for the winning team in each age group. There will be prizes for the winners of each contest as well as for the “Most Improved Player” from each age group. Our final prize will go to the Standout Camper of the Day.
COACH MARSHALLS BASKETBALL TEAMS: NCAA Leading Scoring Leaders 2011 2012 2014 2015 2016
ELIGIBILITY: Girls entering the 3rd grade through those who are entering the 12th grade are eligible to attend the camp. • • • •
NCAA 3pt Shot/ Game Leader 2011 2012 2014 2015 2016
2010-2011 WVIAC Tournament Champions 2011-2012 WVIAC Regular Season Champions 2013-2014 MEC Regular Season Champions 2013-2014 MEC Tournament Champions
Address:___________________________________ County: ___________________________________
Home Phone: _______________________________
School: ___________________________________ Grade: 2017-2018 School Year (check one) q3 q4 q5 q6 q7 q 8 q 9 q 10 q 11 q 12 Camper’s Shirt Size: Adult Sizes (check one) q S q M q L q XL Mail completed registration form with $50 deposit to:
WVSU Girls Basketball Camp Department of Athletics WV State University P.O. Box 1000 Institute, WV 25112 Please Make all Checks Payable to: West Virginia State University Women’s Basketball For more information please contact: Charles Marshall, Head Coach (304) 766-3227 Ginny Mills, Assistant Coach (304) 766-4247 Akeem Scott, Assistant Coach (304) 766-4347
This form must be filled out before registration is complete.
Fleming Hall P.O. Box 1000 Institute, WV 25112
It is the responsibility of the camper’s parent or guardian to ensure that the camper is healthy and has no physical problem that would prevent her participation in all camp activities.
Camper’s Name: _________________________________________ Last
First
Middle
Date of last Tetanus Immunization:
JUNE 26 - 28, 2017 5 - 8 P.M.
_________________________________________ (MM/DD/YYYY)
List any allergies to medication: _________________________________________ _________________________________________ Please list any condition that the camp directors should know about: __________________________ _________________________________________ Emergency Phone Numbers: Day: ______________________________________ Nights: ____________________________________ I authorize any medical treatment that might be advised by physicians available to the Basketball Camp while my daughter is present at the camp. Parent or Guardian Signature: _________________________________________ Date Company Name: ____________________________ Policy Number: _____________________________ Name the Policy is under: _____________________
Place Stamp Here
MEDICAL INSURANCE INFORMATION
REGISTRATION FORM: (please fill in all sections – print with INK only)
INTRODUCTION: Coach Charles Marshall and his basketball teams have a long history of excellence. During the past 5 seasons, Marshall’s teams have lead the nation in scoring, averaging just under 100 points per game. His teams have also lead the nation in 3 point shots made per game with 11 or more. During the 2013-2014 Season Marshall led his team through an “Undisputed!” year. Capturing both the MEC Regular Season Championship and the MEC Tournament Championship, in its initial year. His Team ranked #1 in the Atlantic Region which allowed them to host the first round of game for the NCAA National Tournament. In his short coaching career Marshall’s teams have captured 2 regular season championships as well as 2 tournament championships. In Just first year at State, Coach Marshall lead his team in setting a school record for most points scored in a game with 123pts. Marshall’s teams have a long history of being exciting, fast paced, high scoring, and Championship Winning. Now he wants to host a camp for young girls who want to become part of his winning tradition.
ENROLLMENT: Since enrollment is limited, registration is encouraged as soon as possible, but no later Tuesday, June 20th. Please enclose your $50 deposit with the registration materials. Refund of deposit cannot be made Monday June 12th as monies will already be committed.
PURPOSE: This year’s individual camp will provide unique opportunities for campers to participate in skills sessions and drill work that Coach Marshall’s team uses. The focus will be on improving each camper’s abilities in all aspects of the game.
Camper’s Name: ____________________________
LOCATION: The camp will be located on the campus of West Virginia State University in Institute, WV. The college is located off exit 50 on I-64. Camp activities will be conducted in the Walker Convocation Center.
Age: ______________________________________
FEES:
City: ______________________ State: ___________
The camp cost will cover: camp instruction, basketball, prizes, travel, and a certificate of participation. *Individual Skills Day Camp Fee: $45/camper.
Zip Code:__________________________________
WHAT TO BRING:
Cell Phone:_________________________________
Campers should bring the following items: basketball shoes, water bottle, packed lunches or spending money (food and drinks will be available at Concession Stand.), *bathing suit & towel on specified days.
CAMP FEATURES: • Passing • Form shooting • Ball handling • 3 point shooting • Defense • How to improve at the • Footwork free throw line There will be a 1 on 1 league, 3 on 3 league, and a 5 on 5 league, in which games will be played every day. There will also be a free throw shooting contest, and skills competitions throughout camp. There will be prizes for the winning team in each age group. There will be prizes for the winners of each contest as well as for the “Most Improved Player” from each age group. Our final prize will go to the Standout Camper of the Day.
COACH MARSHALLS BASKETBALL TEAMS: NCAA Leading Scoring Leaders 2011 2012 2014 2015 2016
ELIGIBILITY: Girls entering the 3rd grade through those who are entering the 12th grade are eligible to attend the camp. • • • •
NCAA 3pt Shot/ Game Leader 2011 2012 2014 2015 2016
2010-2011 WVIAC Tournament Champions 2011-2012 WVIAC Regular Season Champions 2013-2014 MEC Regular Season Champions 2013-2014 MEC Tournament Champions
Address:___________________________________ County: ___________________________________
Home Phone: _______________________________
School: ___________________________________ Grade: 2017-2018 School Year (check one) q3 q4 q5 q6 q7 q 8 q 9 q 10 q 11 q 12 Camper’s Shirt Size: Adult Sizes (check one) q S q M q L q XL Mail completed registration form with $50 deposit to:
WVSU Girls Basketball Camp Department of Athletics WV State University P.O. Box 1000 Institute, WV 25112 Please Make all Checks Payable to: West Virginia State University Women’s Basketball For more information please contact: Charles Marshall, Head Coach (304) 766-3227 Ginny Mills, Assistant Coach (304) 766-4247 Akeem Scott, Assistant Coach (304) 766-4347
