Please select one or more session(s) below:
Session 1
Date:
❏ $200
July 6–10
(Per week)
Session 1
Date:
❏ *$150
July 6–10
(Per week)
Session 2
❏ $200
(Per week)
Date:
July 13-17
Session 2
❏ *$150
(Per week)
Date:
July 13-17
Camp Location:
Carl Sandburg Middle School
3439 Highway 516
Old Bridge, NJ 08857
Camp Location:
Carl Sandburg Middle School
3439 Highway 516
Old Bridge, NJ 08857
Camp Location:
Carl Sandburg Middle School
3439 Highway 516
Old Bridge, NJ 08857
Camp Location:
Carl Sandburg Middle School
3439 Highway 516
Old Bridge, NJ 08857
Boys & Girls
Grades 3–12
Boys & Girls
Grades 3–12
Time:
9:00am – 3:00pm
(Free early drop-off at 8am)
Time:
9:00am – 3:00pm
(Free early drop-off at 8am)
Payment by check or
money order, please
make payable to:
Jim Macomber
Mail to:
Boys & Girls
Grades 3–12
Boys & Girls
Grades 3–12
Time:
9:00am – 3:00pm
(Free early drop-off at 8am)
Time:
9:00am – 3:00pm
Jim Macomber
50 Jubilee Circle
Aberdeen, NJ 07747
www.obhoops.com
(Free early drop-off at 8am)
Early Bird Special – $50.00 discount off each session if registration with payment is mail postmarked
* before June
5, 2015. Early registration is strongly encouraged. Enrollment is limited to 140 campers per session. Last year
we were at capacity for two of the three camp sessions. Don’t get shut out! Register early to secure your spot.
Camper’s Informations:
First Name:___________________________________________________________ Last Name:_________________________________________________________
Gender: ❏ Boy
❏ Girl
School:_________________________________________________________________________________________________________
Height:_______’_______” Weight:_________ Grade:__________ Age:_________ Date of Birth: _______/_______/_________
Month
Day
Year
Address: ____________________________________________________________________________________________________________________________________
City / Town:_______________________________________________________________________ State:_______________ Zip Code:_________________________
Please select camper’s last level of play:
❏ None (First time attending a basketball camp)
❏ Recreation
❏ CYO
❏ Travel Basketball
❏ AAU
Camper’s T-shirt Size:
❏ Middle School Team
❏ High School– Freshman
❏ High School– JV
❏ High School–Varsity
❏ Small
❏ Medium
❏ Large
❏ X-Large
* All field are require.
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Parent/Guardian’s Informations:
First Name:_________________________________________________________ Last Name:___________________________________________________________
Home Phone#: (_________) – __________ – ____________
Cell Phone#: (_________) – __________ – ____________
Email: _________________________________________________________________
* All field are require.
Emergency Contact’s Informations:
First Name:_________________________________________________________ Last Name:___________________________________________________________
Relationship to Camper: ______________________________________________________________________ Phone #: (_________) – __________ – ____________
* All field are require.
Camper’s Medical Informations:
* Do Camper have health insurance:
❏ Yes ❏ No
* Insurance Company: _________________________________________________________________
Camper’s Medical History (Please list any important medical history):
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
Camper’s Medications (Please list any medication):
__________________________________________________________
_____________________________________________________________
__________________________________________________________
_____________________________________________________________
__________________________________________________________
_____________________________________________________________
* Require fields.
Medical Waiver & Release
I, the undersigned (Parent/Legal Guardian), attest that my child is physically fit to participate in strenuous athletic activity, and hereby release OB Hoops (OBH)
❏ from
any and all responsibility for injury or illness to my child as a result of my child’s participation in the OB Hoops skills development basketball camps.
Thus, I release and hold harmless Old Bridge Hoops Camp (OBH), Carl Sandburg Middle School, Old Bridge High School, Old Bridge Board of Education,
the camp directors, coaches, any/all OBH officers, independent contractors, or affiliates associated with this program from any and all liability, both joint and
several, arising from or in connection with my child’s participation at OBH. I hereby authorize the directors of OBH to act on my behalf according to their best
judgment in an emergency requiring medical attention. I understand that I am solely responsible for the payment of said medical expenses and must provide
the camp with proof of medical/accident insurance.
I thereby, authorized OBH to use my child’s image (Photograph and or Video) for use in OBH’s publications including, but not limited to videos, email blasts,
brochures, newsletters, website, any other form of print/electronic media, etc. I hereby, waive any rights to royalties or other compensation arising from or
related to the use of my child’s image.
Parent/Legal Guardian Signature:_____________________________________________________________
Parent/Legal Print Name:_____________________________________________________________________
Date:_______________________________________
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