Pine Creek High School
Boys Basketball Camp
Dates: June 13-15, 2017
Time: 9:00-12:00
For: Incoming 4th-9th graders (2016-2017 school year)
Location: Pine Creek High School Gymnasium
10750 Thunder Mountain Avenue
Colorado Springs, CO 80920
Directed by:
PCHS Head Coach Joe Rausch, his coaching staff, and current players
Registration: $65 for early registration received by June 7, 2016
$70 at the door ($5 discount for siblings)
Registration includes a camp t-shirt
Make checks payable to: Pine Creek Boys Basketball
Mail the attached registration form and payment to:
PCHS Boys Basketball Camp
c/o Keith Wilkinson
8216 Andrus Dr
Colorado Springs, CO 80920
During the camp, participants will be involved in player development, contests, and
games. Campers should dress appropriately and bring a water bottle. Camp enrollment
will be limited to ensure quality instruction so early registration is recommended.
For more information email [email protected] or check the Pine Creek Boys
Basketball Facebook page.
Camper Name (please print)_________________________________________________________________________
Address_________________________________________City_______________________State_________Zip_________
Phone__________________________________________Email__________________________________________________
Grade (going into)______________ School_____________________________________________________
Parent ________________________________________Daytime/Work/cell__________________________________
I, ______________________________________________ parent or guardian of ________________________________________
in consideration of my child’s opportunity to participate in the PCHS Boys Basketball camp, hereby
consent to emergency medical treatment, hospitalization or other medical treatment by a physician,
qualified nurse, or hospital in the event of injury or illness during the camp. I hereby waive on behalf
of myself, my spouse (if applicable) and the above named child any liability of Academy School
District #20, its agents or employees arising out of such medical treatment.
Parent or
Guardian signature:__________________________________________________________Date:_____________________________