THE GCU MEN’S BASKETBALL
TEAM INVITES YOU TO GCU’S
SUMMER BASKETBALL CAMP!
TEAM CAMP I
TEAM CAMP II
• 5 Game Guarantee
• Cost $425
• Location: GCU – Lopes Performance
Center, GCU Arena and Men’s
Basketball Practice Facility
• 5 Game Guarantee
• Cost $425
• Location: GCU – Lopes Performance
Center, GCU Arena and Men’s
Basketball Practice Facility
June 1-3, 2017
June 15-17, 2017
BE THE FIRST TO TRY OUT OUR
NEW PRACTICE FACILITY!
SPACE IS LIMITED, SIGN UP TODAY!
Register Online at: gcumensbasketballcamps.com
For more information, contact Luke DallaRiva at
602-639-6845 or [email protected]
2017 DAN MAJERLE BOY’S
BASKETBALL TEAM CAMP
June 1-3 and June 15-17
STATEZIP
WORK PHONE
T-SHIRT SIZE (ADULT SIZES)
PARENT/GUARDIAN NAME
CELL PHONE
Grand Canyon University
Attention: Grand Canyon University Basketball Camps
3300 West Camelback Road
Phoenix, AZ 85017
Checks must be made payable to
Grand Canyon University Basketball Camps.
Send payment and completed registration form to:
This registration grants permission to Grand Canyon Education Inc. (and its designees and
agents) to utilize the camp attendee’s image, likeness, actions and statements in any live or recorded audio, video, or photographic display or other transmission, exhibition, publication or
reproduction made of, or at, the Event in any medium or context for any purpose, including commercial or promotional purposes, without further authorization.
REGISTER ONLINE AT GCUMENSBASKETBALLCAMPS.COM
$ AMOUNT ENCLOSED (MIN $200 DEPOSIT REQUIRED)
o TEAM CAMP II: June 15-17, 2017 — $425 Camp Fee for One Team
o TEAM CAMP I: June 1-3, 2017 — $425 Camp Fee for One Team
GCU TEAM CAMP - JUNE 1-3, 2017 & JUNE 15-17, 2017
Date
Signature of Parent/Guardian (if participant is under 18)
Date
Date
Per NCAA Bylaw 13.12.1.3, our camps are open to any and all entrants (limited only by grade level). GCU, while reserving its lawful rights in light of its Christian mission, is committed to
maintaining an academic environment that is free from unlawful discrimination. Further detail on GCU’s Non-Discrimination policies can be found at gcu.edu/titleIX
FOR MORE INFORMATION, CONTACT LUKE DALLARIVA AT 602-639-6845 OR [email protected]
Signature of Parent/Guardian
17ATH0036
As the parent/guardian of the above mentioned participant, I understand the above statements and give consent for the named participant to engage in sport related participation at
Grand Canyon University.
If the participant is a minor, the following portion must also be completed by the parent/guardian:
Signature of Participant
Having understood the risks of participation and particularly the risk inherent in sport, I voluntarily assume and accept these risks as they have been explained above. I realize that the coaches,
administrators, and Grand Canyon University personnel will do those things necessary to reduce the risk of injury. However, I realize and accept that these measures will not prevent all injuries to
myself or to other participants. I also accept the responsibility in taking personal measures to help prevent injury to myself or other participants by notifying coaches, or other Grand Canyon University
personnel of conditions that I am aware of that may predispose me or other participants to an increased risk of injury resulting from participation.
Date
Signature of Participant
I have read the above statement and understand that participating in recreational sporting activity has inherent risks of possible bodily damage or injury as explained above.
I am aware that the very nature of participation in recreational sports activity carries with it an inherent risk of injury. I understand that the dangers and risks of participating in these activities, whether
in competition or preparing to compete, include, but are not limited to, death, serious neck and spinal injuries which may result in complete or partial paralysis, brain damage, serious injury to virtually all
bones, joints, ligaments, muscles, tendons, and other aspects of the muscular skeletal system, and serious injury or impairment to other aspects of my body and general health and well being.
Participant Name: (please print)
ACKNOWLEDGMENT OF RISK AND CONSENT TO PARTICIPATE
EMAIL ADDRESS
EMERGENCY CONTACT
HOME PHONE
AGE (DURING CAMP)GRADE (NEXT YEAR, FALL 2017)
CITY
ADDRESS
CAMPER’S NAME
HIGH SCHOOL
SUMMER BASKETBALL CAMPS REGISTRATION FORM