RBA Basketball Camp
Camp Features
Registration Form
5 on 5 Games
Hot Shot Competition
1 on 1 Games
Free Throw Contest
3 on 3 Games
Individual Stations
Guest Speakers
& More
(please print clearly)
Child’s Name
School
Age
Grade
Address
Camp Offers
Camp T-Shirt
Daily and Weekly Prizes
Premier Facilities
Division I Counselors
City, State, Zip Code
Parent/ Guardian Email Address
RBA
Basketball
Camp 2017
@
The
Haverford
School
---------------------The Haverford School Basketball
2016-17 Highlights
Emergency Contact Name & Phone Number
Make Checks Payable to:
Rogers Basketball Academy
Cost: $215 before June 15
$245 after June 15
Detach and mail this form
along with your check to:
Rogers Basketball Academy
1228 Jennifer Road
Philadelphia, PA 19116
Questions?
Contact Coach Bernie Rogers
[email protected]
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19-7 overall and 7-3 in the Inter-Ac
Both Kharon Randolph and Christian
Ray were named 1st Team All InterAc
Defeated Kiski Prep in the first
round of the state playoffs.
Notable Victories: Shipley, Girard
College, Germantown Academy,
Episcopal Academy, Spring-Ford
July 24-27
9AM - 3PM
Ages 7-15
Rogers Basketball Academy
Early bird rate: $215 (by June 15)
Regular Rate: $245 (after June 15)
Director: Bernie Rogers
------------------Letter from the Director

Dear Parents,

I would like to take this
opportunity to invite your child to
our 2017 RBA Basketball Camp
hosted by The Haverford School.
At our camp we will
emphasize individual skills and
teamwork to all campers. They
will drill and compete with their
age groups in various competitions
such as dribbling, passing,
shooting, and defense.
Hope to see you and your
child at our camp!
~ Coach Bernie Rogers
Medical Waiver:
Meet the Camp Staff
Cost:
 Head Basketball Coach at
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The Haverford School
17 years of head
coaching experience
2001, 2002, 2007, and
2008 Coach of the Year
College Point Guard at
Ursinus College
All-Time leader in assists at Archbishop
Ryan High School
Philadelphia All-Catholic in 1991 & 1992
Member of Archbishop Ryan Boys’
Basketball Hall of Fame
Coach Rogers’ Staff
Andrew Rogers
 Assistant Varsity Basketball Coach at The
Haverford School
 Former Division I point guard at the University of Maine
 2008 City Player of the Year and Catholic
League MVP
I/We the parents/guardians of:
Camper’s Name
state the he/she is in good health and has my permission to participate in the 2017 RBA Basketball
Camp at The Haverford School. I authorize the
staff at the camp to provide emergency first aid in
the event of sickness or injury. I also give my
permission for the coach/staff member to sign for
me in the event that emergency treatment, hospitalization, and/or surgery is required. I understand
I am financially responsible for any medical bills
incurred by my child while at the 2017 RBA
Basketball Camp.
My signature below hereby releases camp directors, organizers, coaches, workers, The Haverford
School, and any agents or employees of the above
from any and all liability and any manner of actions, suits, damages, claims, and demands arising
from participation in the camp.
Please list any medical conditions the camp
workers/ volunteers should be aware of:
Keith Czarny
 Head Junior Varsity Basketball Coach at
The Haverford School
 Assistant Varsity Basketball Coach at The
Haverford School
 9 years of high school coaching experience
Also, including members of The Haverford
School basketball program
Insurance Company
Policy Number
Signature of Parent/Guardian
Date Signed