This form must be completed, including the parent or legal guardian signature for students 17 years or younger.
Registration forms must be submitted to the Community Education Office in person, by mail, or fax.
Student Information (please print all information)
Last Name
First Name
M.I.
Address
City
State
Primary Phone
Birthdate
Entering Grade
SSN#
Email Address
Zip
LEE COLLEGE
Athletics
PO Box 818, Baytown, Texas 77522-0818
Lee College Community Education Permission/Emergency Registration Form
LEE COLLEGE
BASKETBALL
summer camp
Male
Female
SUMMER CAMP
Does this child have any disabilities, present injuries, allergies, hemophilia, heart conditions, history of respiratory illness, or any other significant medical condition?
Yes
No If yes, please state: _______________________________________________________________
Parent/Guardian: ________________________________
2nd Contact (relationship): __________________________
Home/Cell Phone:
Home/Cell Phone:
______________
______________
Work Phone: ___________________________________
Work Phone: ___________________________________
Employer: _____________________________________
Employer: _____________________________________
If I cannot be reached, please contact the person listed below:
Full Name (family, friend): ___________________________
Phone: _______________________
In case of emergency, I hereby authorize treatment and/or care as deemed necessary by the Lee College staff.
Doctor’s Name: __________________________________
Phone: _______________________
Parent or Guardian’s Signature
Grades K - 12 (Coed)
Date
GRADES K - 12
(COED)
Model Release: I do do not (check one) grant Lee College permission to use my name/child’s name, photograph, and comments for marketing, advertising, college relations,
and promotional purposes. I understand I will not be paid for any use of my image in any Lee College marketing materials now or in the future.
Non-Release of Directory Information: I do do not (check one) grant Lee College permission to release Directory information to the general public without written consent.
Directory items include the student’s name, address, major, activities participated in, dates of attendance, and degrees and awards received.
Girls K - 4th grades
Girls 5th - 10th grades
Boys K - 4th grades
Boys 5th - 10th grades
Shooting Camp
PAID
Session:
For Office Use Only
Student I.D.
Receipt #
Date
Initials
RD
FERPA
!"#$%&!"''
BASKETBALL CAMPS
CAMP REGISTRATION STARTS MAY 1, 2017
Due to the overwhelming response
from last year’s camp, only a limited
number of applications per session
will be accepted. Each session will be
on a first-come, first-served basis
Shooting Camp (Coed 7th - 12th grades)
174KAC10012
July 5 - 7
W
1:00 pm - 4:00 pm
Th-Fri
9:00 am - 12:00 pm, 1:00 pm - 4:00 pm
Girls K - 4th grades
174KAC10011
June 26 - June 30
M-Th 8:00 am - 1:00 pm
F 8:00 am - 12:00 pm
Boys K - 4th grades
174KAC10014
July 17 - 21
M-Th 8:00 am - 1:00 pm
F 8:00 am - 12:00 pm
Girls 5th - 10th grades
174KAC10013
July 10 - 14
M-Th 8:00 am - 1:00 pm
F 8:00 am - 12:00 pm
Boys 5th - 10th grades
174KAC10015
July 24 - 28
M-Th 8:00 am - 1:00 pm
F 8:00 am - 12:00 pm
TYPICAL CAMP DAY
08:00 – 08:15 Warm up, stretching, and easy running
08:15 – 08:30 Pistol Pete ball-handling routine
08:30 – 09:40 Station work
09:40 – 10:00 Break time
10:10 – 10:15 Mikan layups
10:15 – 10:40 Hot shot shooting competition
10:40 – 11:00 Freethrow shooting
11:00 – 12:00 Lunch (bring money or a lunch)
12:00 – 01:00 3-on-3 games
CAMP FEATURES
Air-conditioned arena
Camp t-shirt
Motivational booklet
Daily refreshments
Special guest speakers
Enthusiasm
Family atmosphere
Certified licensed trainer
Camp basketball
Camp certificate
909 Decker Drive, Baytown, TX
Fax:
281.425.6855 (Visa, MC, Discover, AMEX)
By Mail:
Lee College Community Education
P.O. Box 818
Baytown, TX 77522-0818
For more information call 281.425.6311
Choose Payment Type:
COST
All camps are $95 per person
(Fee includes camp basketball and
t-shirt.)
Cash
Discounts for children in the same family. First child pays $95. Each
additional family member (brother or sister) pays $50.
FACILITIES
All camps will be conducted in the Lee College Sports Arena. The arena
was built in 2003 and has the capacity to seat 1,500 screaming fans. The
arena also boasts a wellness center, multiple locker rooms, a training
room, film room, and two regulation basketball courts.
EQUIPMENT
Campers should report each day wearing basketball shoes, athletic
socks, shorts, and camp t-shirt. No caps, watches, or jewelry will be
permitted, PLEASE!
SHOOTING CAMP
Coed 7th - 12th grades
Individual breakdown of shot
Footwork/shot preparation
How to get open to score
Freethrow shooting
#())%*+,")-
WAYS TO REGISTER
In person:
Live/deadball drills
Learn how to study your shot
Film breakdown of each
camper’s mechanics
SHOOTING CAMP DATES:
Wednesday, July 5 1:00 pm - 4:00 pm
Thursday, July 6
9:00 am - 4:00 pm
Friday, July 7
9:00 am - 4:00 pm
Food will not be provided for campers. Make sure to either bring lunch or money.
CAMP AWARDS
An awards ceremony will conclude each week of camp. The ceremony
will be conducted at 11:50 each week with awards for each age group for
the following categories:
Mikan layups
Hot shot shooting
Freethrow shooting
3-on-3 competition
In addition, every camper will receive a certificate of merit for
participation in the camp.
CAMP GOALS
Each camper will leave with a positive attitude.
Each camper will leave the camp closer to reaching their full
potential on the basketball court.
Each camper will learn the proper fundamentals and develop the
confidence in their abilities so they can utilize the skills they learned
in the camp.
Each camper will learn how to appreciate and love the game of
basketball.
Each camper will be exposed on how to conduct themselves on and
off the court through sportsmanship, competition, and learning how
to deal with winning and losing.
Each camper will learn that to be successful they will need to find
the dedication, desire, and discipline to be successful in basketball
and, most importantly, in life.
CAMP STORE
The camp store will be open for business each day after camp concludes.
Runnin’ Rebel merchandise and other items will be available for
purchase. Lee College will provide a camp bank so campers can store
their money without the fear of losing or misplacing it.
Check
Visa
MC
Discover
AMEX
____________________________________________
Card Number
___________________________
Exp. Date
______________
CVV Code
____________________________________________
Print Cardholder Name
Please make all checks payable to Lee College.
Check #__________ TDL #_____________________
Exp. Date __________________
Registration fees are to be deposited into the Lee College basketball fundraising account
and will help to fund future needs for the Runnin’ Rebels program.
Camp Directed by
ROY CHAMPAGNE
Head Coach at Lee College for 23 years
Career Highlights
For the first time in school history, led
2012-2013 Runnin` Rebels to Region XIV
Champions and "Sweet 16" appearance at
NJCAA national Tournament
AAU coach for over 10 years
Led his AAU team to a National
Championship in 1991
Coached 10 players who have gone on
to play professional basketball