Waiver and Liability Form
MACOMB
BOMBER
I have of my own initiative signed up as a
participant in the Macomb Bomber
Basketball Camp being held at Macomb
High School. I understand that the director,
coaches, or community school district
cannot be held responsible for the payment
of any medical fees resulting from sickness,
accident, or injury while I am participating
in summer camp activities. I also
understand that any unsportsmanlike
conduct on my part, on the floor or in the
building, will result in my suspension from
the camp. I will make restitution for any
destruction of property that I cause on the
property of Macomb School District.
______________________________
Player Signature
______________________________
Parent or Legal Guardian Signature
BOYS
BASKETBALL
CAMP
2017
Be a part of the
Macomb Basketball
Tradition
June 19-22
Camp Registration
Camp Directors
Dates:
_______________________________________
Last Name
First Name
Coach Jeremy Anderson
June 19-June 22
_______________________________________
Street
Assistant Coaches Brock Bainter and
Brian Langworthy
Grades & Times:
Camp Features
Instruction by high school boys staff
2nd & 3rd Grade:
8:00 – 9:30 AM
th
th
4 & 5 Grade:
9:30 – 11:00 AM
th
th
th
6 , 7 , & 8 Grade: 11:00 – 12:30 PM
(Grade as of Fall of 2017)
Team concept instruction
________________
Home Phone
___________________
Emergency Phone
Check Camp Attending (Grade in Fall 2017)
_______ 2nd & 3rd Grade: 8:00-9:30
_______ 4th & 5th Grade: 9:30-11:00
_______ 6th, 7th, & 8th Grade: 11:00-12:30
Individual fundamental instruction
Tournaments and Competitions
_______________________________________
City
Zip
Location:
Macomb High School Gym
T-shirt size (circle one)
Adult
Youth
S
S
M
M
L XL
L
Please make checks payable to:
Coach Jeremy Anderson
Questions/Comments
Cost:
Call Coach Anderson
309.368.8623
$30.00 per camper
Send Registration to:
Coach Jeremy Anderson
Macomb High School
1525 S. Johnson Street
Macomb, IL 61455