Camper Application
Name___________________________
M/F ____________________________
Address _________________________
City __________State ____ Zip _____
Home Phone _____________________
Work Phone _____________________
Cell Phone ______________________
Email __________________________
Emergency Contact _______________
Emergency Contact Phone __________
Doctor’s Name ___________________
Doctor’s Phone ___________________
Medical Insurance Co. _____________
Policy # _________________________
Medical conditions the NBA staff should
be aware of ______________________
_______________________________
Coaches Contact
Information
•
Kristin Meyer (515) 460-0545 or
[email protected]
•
Chris Hinson (515) 290-6504 or
[email protected]
•
Joel Fey (515) 291-4602 or
[email protected]
Mail check, application, and
medical release to:
Nevada Basketball Association
c/o Joel Fey
Central Elementary
910 10th Street
Nevada, IA 50201
Registration deadline is July 1st
N EVADA
B ASKETBALL
A SSOCIATION
2014 S UMMER
B ASKETBALL
C AMP
July 14-17 th
SESSIONS
CAMP FEATURES
(Grade entering the
2014-2015 school year)
• Coaching from the varsity
boys and girls basketball
coaching staffs
• Age appropriate instruction
for every athlete
• Quality instruction from
current and former high
school basketball players
• Low camper to staff ratio
• Tournaments and skill
competitions
3rd-4th Grade
(10:30am-noon @ NHS)
5th-6th Grade
(10:30am-noon @ NMS)
7th-8th Grade Boys and Girls
(12:00-1:30pm @ NHS)
AREAS OF FOCUS
Ball handling
Shooting
Defensive Skills
Free Throws
Individual Offensive Skills
EACH CAMPER
RECEIVES
a Nevada Cubs basketball
! AM Session (Grades 3rd-4th)*
! AM Session (Grades 5th-6th)*
! PM Session (Grades 7th-8th)*
* Grade entering the
2014-2015 school year
Medical Release
In consideration of the acceptance for
enrollment in the Nevada Basketball
Camp, I waive and release any and all
rights and claims for damages I may have
against any person associated with the
camp for any and all damages which may
be sustained and suffered in connection
with my son’s or daughter’s entry into
camp. I agree to pay all costs, present
and future through our medical insurance
and/or personal finances.
Parent/Guardian Signature
_________________________________
Date _____________________________
CAMP TUITION
•
•
*New this summer!
Session (check one):
•
•
$40 per camper or 2 campers for $70
(if in the same family)
Please send full payment with
application.
Deadline is July 1.
Please make checks payable to
Nevada Basketball Association
Mail check, application, and
medical release to:
Nevada Basketball Association
c/o Joel Fey
Central Elementary
910 10th Street
Nevada, IA 50201