What: Boys and Girls youth basketball camp
When: May 30-June 1
Time: 9:00-12:00
Where: CM HS/MS Gym For: Students entering 1st-8th grade 2017-18 school year
Cost: $30 Fee includes: basketball and t-shirt
Why: Learn more about basketball, improve skill development, be with your friends, gain a better
interest for basketball, meet the high school coaches and players, and get instruction in areas that apply
to game situations.
Pre-registration ends May 19. This is very important to make sure every camper gets a t-shirt that fits
him/her. Registration at the door will be $35 (a $5 late fee)
The camp agenda will include instructional groups for dribbling, passing, shooting, defense,
competitions, and some 3 vs 3 games.
Coach Todd Cook (937.901.5788) [email protected]
Coach Tim McGraw (937.725.0300) [email protected]
*************************************************************************************
Cut Here and Mail Bottom Portion with Payment by May 19, 2017 Deadline
Please select only one size: Youth MED___; Youth LG___ Adult SM___; Adult M___; Adult LG___; Adult XL___
Make Checks to Clinton Massie High Athletics Mailing Address: ATHLETIC DEPT. - 2556 Lebanon Rd
Clarksville, OH 45113 ATTN: Cindy Running Basketball Camp
Camper Name: ________________________ School/Grade (2017/2018)_______________
Street Address: ____________________________________City:_____________________
Zip_________Emergency Phone:______________________________________
Parent/Guardian Permission Form
Parent/Guardian
PRINT:______________________________________________________________________
Parent/Guardian
Signature:___________________________________________________________________
I certify that my son has no injury that would limit his participation in camp. I hereby release and exonerate
and discharge the camp and their employees/volunteers from any and all actions or cause of actions, known
or unknown, from any injuries incurred before, during, or after camp. The above parent do herby delegate
Clinton Massie School District employees or agents the authority to seek, obtain, or approve medical
treatment for the above named minor, which is in their judgment is necessary for the health and well-being of
said minor during his attendance at the Clinton Massie Basketball Camp. Further, I agree to hold Clinton
Massie Basketball Camp, its employees or agents, harmless for any liability arising out of and good
faith actions taken in seeking and obtaining medical care and treatment for the above named minor. All
costs incurred are the responsibility of the parent/guardian. Are there any Physical or Medical conditions
that our coaching staff should know?