CORNELL COLLEGE SUMMER CAMP
ACKNOWLEDGMENT AND ASSUMPTION OF RISK AND
MEDICAL CONSENT FORM
Cornell College
Basketball Camps
I, the undersigned camp athlete, do hereby expressly and affirmatively state that I voluntarily wish to praticipate in the Cornell College
Basketball Camp.
I realize that my participation in this activity inherently involves risk
of injury, including but not limited to the following: death, neck and
spinal injuries (whick may result in complete or partial paralysis), brain
damage, injury to internal organs, injury to the skeletal system, and
injury or impairment to the body’s general health and well-being. In
addition, I acknowledge that injury may also result in serious impairment of future abilities to earn a living, engage in other business,
social and recreational activities, and generally enjoy life. These types
of injuries may result from my own actions, the actions or inactions of
others or a combination of both.
I understand that the rules and regulations are designed for the
safety and protection of the participants and I hereby agree to abide
by the rules and regulations administered by the camp staff. I also
understand that certain activities require a minimum level of fitness
for safe participation.
I acknowledge that I fully understand the contents of this Acknowledgment and Assumption of Risk statement before signing the same
and have had an opportunity to ask questions. All questions I have
asked have been answered to my complete satisfaction. Having done
so, I agree to assume any and all potential risks of these activities
and agree to hold Cornell College, its officers, employees, and agents
harmless for liabilities as it relates to this activity.
I hereby grant permission to the Cornell College camp staff, team
physician, athletic trainers, and other medical personnel to render aid,
emergency treatment, medical or surgical care, preventative, rehabilitative care deemed reasonably necessary to my health and well being.
Parent(s) or Legal Guardian Signature
Friday, April 10
Girls/Boys Three-On-Three Tournament
June 22-26
Date
Date
CONTACT INFORMATION IN CASE OF
EMERGENCY:
NAME __________________________________________
ADDRESS _______________________________________
CITY ___________________STATE ____ZIP ___________
E-MAIL __________________________________________
CELL PHONE ____________________________________
GRADE (Fall ‘15)__________
Girls/Boys Day Camp
Brent Brase
Cornell College
600 First Street SW
Mount Vernon, IA 52314
Camp Athlete Signature
2015
July 23-26
Girls/Boys Elite Academy
www.cornellcollege.edu/athletics/
camps-clinics/index.shtml
GIRLS/BOYS DAY CAMP
June 22-26
• Morning session for grades K-5, 9 a.m.-noon
• Afternoon session for grades 4-9, 1-4 p.m.
• Friday session will include a parent program for
each session
• Cost: $80.00
• Director: Brent Brase, Cornell Women’s Basketball
The girls’ and boys’ middle school camp stresses
fundamentals while incorporating team concepts and
play Emphasis will be placed on developing individual
offensive and defensive skills. Teaching sessions will
include instruction on shooting, dribbling, passing,
rebounding, team defense, team offense, individual
defense, and individual offense.
The girls’ and boys’ elementary camp is designed to
introduce and teach the basic fundamentals of basketball. The camp utilizes a variety of innovative teaching
methods, drills, and games to teach these fundamentals
while not losing sight of the primary purpose of camp:
TO HAVE A GREAT EXPERIENCE!
Each camper will receive a Cornell basketball shirt.
GIRLS/BOYS ELITE ACADEMY
July 23-26
• Grades 4-9
• Cost: $210/Commuter or $260/Resident
• Check-in: Thursday, 5-6 p.m.
• Daily Sessions: 9-11:30 a.m., 1-5 p.m., 6:30-9 p.m.
• Check-out: Sunday, 11 a.m.
• Includes Point Guard, Shooting Guard, and Post
Player breakdown sessions.
The goal of the camp is to refine fundamental basketball
techniques, while also introducing and developing
advanced skills, and concepts necessary to take your
game to the next level. The high intensity level, combined with low player to coach ratios, will maximize
your skill development and confidence.
• Commuters: lunch and dinner included in cost
• Resident: all meals and housing included in cost
GIRLS/BOYS THREE-ON-THREE TOURNAMENT
Friday April 10
• Divisions: 2nd/3rd grade, 4th/5th grade,
6th/7th grade, 8th/9th grade
• 6 p.m. start time
• Registration deadline: April 6
• Cost: $40.00/team
• Gender: boys and girls
• T-shirts for all first place teams
• Three games guaranteed
• Games are played to 30 points or 20 minutes
• Maximum five player roster
• Grades will be split if enough teams in each grade
• Rules will be sent to the team captain
CAMP(S) ATTENDING
Girls/Boys Three-On-Three Tournament: April 10
Team Name_________________________________
Divisions:___2nd/3rd ___4th/5th ___6th/7th ___8th/9th
Gender: ___Boys ___Girls
Registration deadline: April 6
Cost: $40.00/team
Captain Contact info: Name______________________
Address______________________________________
City___________________State_____Zip__________
Email_______________________________________
1) Player name______________________grade_____
Parent Signature______________________________
2) Player name______________________grade_____
Parent Signature______________________________
3) Player name______________________grade_____
Parent Signature______________________________
4) Player name______________________grade_____
Parent Signature______________________________
5) Player name______________________grade_____
Parent Signature______________________________
For camp information contact:
Brent Brase, Women’s Basketball Coach
[email protected]
319-895-4265
Girls/Boys Day Camp: June 22-26
_____Commuter a.m. (9 a.m.-noon, Grades K-5) $80
_____Commuter p.m. (1-4 p.m., Grades 4-9) $80
Amount enclosed____________
Girls/Boys Elite Academy: July 23-26
Cost: $210/Commuter___ or $260/Resident___
Amount enclosed___________Deposit Required $50
REGISTRATION DEADLINE: July 18th
REGISTRATION
First Name______________________________
Last Name______________________________
Male
Female
Address________________________________
_______________________________________
City_______________State_____Zip________
Home Phone____________________________
Cell Phone______________________________
Email__________________________________
Grade Fall ‘15__________
T-shirt size __YS__YM__YL__AS__AM__AL
Preferred Roommates (For Elite Academy)
_______________________________________
___________________________________________
________________________________________
MAIL TO:
Brent Brase
Cornell Athletics,
600 First Street SW,
Mount Vernon, IA 52314