wartburg basketball
School ___________________________________________ Summer address ___________________________________ City _____________________________________________ State ____________________ ZIP_____________________
2018
NONPROFIT ORG US POSTAGE PAID WARTBURG COLLEGE
REGISTRATION
WARTBURG BASKETBALL
Coach___________________________________________
SHOOTOUT FOR GIRLS HIGH SCHOOL VARSITY/JUNIOR VARSITY TEAMS
Cell phone________________________________________ Email____________________________________________
hosted by Wartburg Women’s Basketball Program Wartburg College | Waverly, Iowa
School size ____ 1A ____ 2A ____ 3A ____ 4A ____ 5A Level ____ Varsity ____ Junior Varsity Coach T-shirt size (circle one): M L XL XXL Assistant coach T-shirt size (circle one): M L XL XXL Brief description of competitive level for next season: ________________________________________________ ________________________________________________
(prior to June 1), $450 (after June 1). o We are interested in on-campus housing. Please send
additional information (see inside for pricing). Nonrefundable $100 deposit required with registration form. Please make copies of the parental release form on the back of this registration form for each player to complete.
My check is enclosed for $____________________________ Please make checks payable to Wartburg Women’s Basketball.
Send registration and payment to:
Wartburg Girls Basketball Summer Shootout c/o Bob Amsberry 100 Wartburg Blvd. P.O. Box 1003 Waverly, IA 50677-0903
For more information:
319-352-8364 [email protected]
Register early! Space is limited!
CHANGE SERVICE REQUESTED
o Girls Summer Shootout, July 16-17 - Cost $400 per team
c/o Bob Amsberry 100 Wartburg Blvd. P.O. Box 1003 Waverly, IA 50677-0903
I plan to attend:
Wartburg Girls Basketball Summer Shootout
________________________________________________
JULY 16-17
Wartburg-Waverly Sports & Wellness Center (The W)
Five games guaranteed, including tournament play on second day
@WartburgWBBALL
COST
LODGING
$400 per team (prior to June 1)
If you need lodging, please consider our hotel partners:
$450 per team (after June 1)
PARTICIPANTS 3 Shootout is limited to 64 teams 3 Varsity and junior varsity pools 3 Appropriate competition in each pool
GAMES 3 Guaranteed a minimum of five games, including
tournament play on day two 3 Tournament seedings based on
pool play results 3 Certified officials
PARENTAL RELEASE FORM We (I) hereby give our (my) permission to Wartburg College to provide medical attention to our (my) child
AMERICINN LODGE & SUITES
5818 Nordic Drive Cedar Falls, IA 50613 Reservations: 319-277-6166 (Mention Wartburg Shootout to get rate of $79.99 + tax.)
1614 Technology Parkway Cedar Falls, Iowa 50613 Reservations: 319-277-2400 (Mention Wartburg Shootout to get rate of $89.99 + tax.)
_________________________________________________ in the event of injury or illness. We (I) hereby release Wartburg College, camp workers, and all its employees from all claims (present and future) resulting from any injuries that may be sustained by our (my) child while attending the Wartburg Summer Shootout. We (I) also certify that our (my) child is medically fit to participate in the camp and that we (I) will be responsible for any medical or other charges in connection with attendance at the camp.
ON-CAMPUS HOUSING
Medical insurance company ____________________________
Double room, with air, per person (includes breakfast) $22 Single room, with air, per person (includes breakfast) $28 (Space is limited)
Date ______________________________________________
BEST WESTERN PLUS
3 Score table responsibilities
provided by the camp
REGISTRATION Complete both sides of this form and return with $100 deposit. Make checks payable to Wartburg Women’s Basketball.
Please attach a copy of the insurance card covering the participant.
Signed (parent/guardian) ______________________________ (parent/guardian) ______________________________
FACILITIES
Where possible, BOTH parents/guardians must sign this release.
Among the largest NCAA Division III facilities of its kind in the nation, the Wartburg-Waverly Sports & Wellness Center accommodates Wartburg health and wellness programs and intercollegiate athletics and also serves as a community recreation center. Its seven full-size playing courts include three wood courts in Levick Arena and Center Court.
LOCATION The W, on the corner of Fifth Avenue NW and 12th Street NW, Waverly, IA.
Wartburg-Waverly Sports & Wellness Center
12
St.
e. er Av
NW
Brem 18 way 2 (High
)
and 3
Address ____________________________________________ City _______________________________________________ State ______________________ ZIP _____________________ Home phone _______________________________________ Parent cell phone_____________________________________ Email ______________________________________________ All individuals enrolled are required to comply with the rules and regulations of Wartburg College and the Sports Camps. Any violation of these rules and regulations could cause immediate dismissal from the camp.
2018
NONPROFIT ORG US POSTAGE PAID WARTBURG COLLEGE
REGISTRATION
WARTBURG BASKETBALL
Coach___________________________________________
SHOOTOUT FOR GIRLS HIGH SCHOOL VARSITY/JUNIOR VARSITY TEAMS
Cell phone________________________________________ Email____________________________________________
hosted by Wartburg Women’s Basketball Program Wartburg College | Waverly, Iowa
School size ____ 1A ____ 2A ____ 3A ____ 4A ____ 5A Level ____ Varsity ____ Junior Varsity Coach T-shirt size (circle one): M L XL XXL Assistant coach T-shirt size (circle one): M L XL XXL Brief description of competitive level for next season: ________________________________________________ ________________________________________________
(prior to June 1), $450 (after June 1). o We are interested in on-campus housing. Please send
additional information (see inside for pricing). Nonrefundable $100 deposit required with registration form. Please make copies of the parental release form on the back of this registration form for each player to complete.
My check is enclosed for $____________________________ Please make checks payable to Wartburg Women’s Basketball.
Send registration and payment to:
Wartburg Girls Basketball Summer Shootout c/o Bob Amsberry 100 Wartburg Blvd. P.O. Box 1003 Waverly, IA 50677-0903
For more information:
319-352-8364 [email protected]
Register early! Space is limited!
CHANGE SERVICE REQUESTED
o Girls Summer Shootout, July 16-17 - Cost $400 per team
c/o Bob Amsberry 100 Wartburg Blvd. P.O. Box 1003 Waverly, IA 50677-0903
I plan to attend:
Wartburg Girls Basketball Summer Shootout
________________________________________________
JULY 16-17
Wartburg-Waverly Sports & Wellness Center (The W)
Five games guaranteed, including tournament play on second day
@WartburgWBBALL
COST
LODGING
$400 per team (prior to June 1)
If you need lodging, please consider our hotel partners:
$450 per team (after June 1)
PARTICIPANTS 3 Shootout is limited to 64 teams 3 Varsity and junior varsity pools 3 Appropriate competition in each pool
GAMES 3 Guaranteed a minimum of five games, including
tournament play on day two 3 Tournament seedings based on
pool play results 3 Certified officials
PARENTAL RELEASE FORM We (I) hereby give our (my) permission to Wartburg College to provide medical attention to our (my) child
AMERICINN LODGE & SUITES
5818 Nordic Drive Cedar Falls, IA 50613 Reservations: 319-277-6166 (Mention Wartburg Shootout to get rate of $79.99 + tax.)
1614 Technology Parkway Cedar Falls, Iowa 50613 Reservations: 319-277-2400 (Mention Wartburg Shootout to get rate of $89.99 + tax.)
_________________________________________________ in the event of injury or illness. We (I) hereby release Wartburg College, camp workers, and all its employees from all claims (present and future) resulting from any injuries that may be sustained by our (my) child while attending the Wartburg Summer Shootout. We (I) also certify that our (my) child is medically fit to participate in the camp and that we (I) will be responsible for any medical or other charges in connection with attendance at the camp.
ON-CAMPUS HOUSING
Medical insurance company ____________________________
Double room, with air, per person (includes breakfast) $22 Single room, with air, per person (includes breakfast) $28 (Space is limited)
Date ______________________________________________
BEST WESTERN PLUS
3 Score table responsibilities
provided by the camp
REGISTRATION Complete both sides of this form and return with $100 deposit. Make checks payable to Wartburg Women’s Basketball.
Please attach a copy of the insurance card covering the participant.
Signed (parent/guardian) ______________________________ (parent/guardian) ______________________________
FACILITIES
Where possible, BOTH parents/guardians must sign this release.
Among the largest NCAA Division III facilities of its kind in the nation, the Wartburg-Waverly Sports & Wellness Center accommodates Wartburg health and wellness programs and intercollegiate athletics and also serves as a community recreation center. Its seven full-size playing courts include three wood courts in Levick Arena and Center Court.
LOCATION The W, on the corner of Fifth Avenue NW and 12th Street NW, Waverly, IA.
Wartburg-Waverly Sports & Wellness Center
12
St.
e. er Av
NW
Brem 18 way 2 (High
)
and 3
Address ____________________________________________ City _______________________________________________ State ______________________ ZIP _____________________ Home phone _______________________________________ Parent cell phone_____________________________________ Email ______________________________________________ All individuals enrolled are required to comply with the rules and regulations of Wartburg College and the Sports Camps. Any violation of these rules and regulations could cause immediate dismissal from the camp.
