ST. AUGUSTINE SUMMER BASKETBALL CAMP
MEDICAL AND LIABILITY RELEASE STATEMENT, CODE OF CONDUCT AND PHOTO RELEASE
This FREE summer basketball camp is presented by St. Augustine Catholic Church, located at 1169 Kerr Avenue, Memphis, TN 38104, in partnership with The Fundamentals Academy and ATOK Basketball. Camps will take place under the guidance of Coach Earl Harden (Sessions A1 & A2) and Coach Michael Isbell, Jr (Sessions F1 & F2). We encourage participants to continue their basketball journey with either of these programs upon completion of camp.
CAMP INFORMATION: 4 sessions over 3 weeks focusing on dribbling, passing, shooting, defense, & teamwork
Pick One |
Session |
Dates |
Time |
Coach |
Ages |
Participant's Age |
Grade (Entering) |
Tshirt Size |
|
Pick One
|
Session
|
Dates
|
Time
|
Coach
|
Ages
|
Participant's Age
|
Grade (Entering)
|
Tshirt Size
|
|
A1
|
June 24-25
|
9am-12pm
|
Earl
|
8-14
|
|
A1
|
July 1-5
|
9am-12pm
|
Earl
|
8-14
|
|
F1
|
June 24-25
|
5pm-8pm
|
Michael
|
5-10
|
|
F1
|
July 1-5
|
5pm-8pm
|
Michael
|
5-10
|
I ____________________________ grant permission for my child, __________________________________ to participate in the St. Augustine Church Summer Basketball Camp.
I
NOTE: This camp is free, however due to limited spots, a $20 refundable deposit is required to secure each participant’s spot. The deposit will be returned in cash upon completion of the camp. By signing this form, I agree to pay a $20 refundable deposit, due at the time of confirmation of acceptance in the camp.
I understand that by signing this form, in the event medical intervention is necessary, every attempt will be made to contact immediately the persons listed on this form. If I cannot be reached in an emergency during the activity dates shown on this from, I give my permission to the physician or dentist selected by the activity leader to hospitalize, to secure medical treatment and/ order an injection, anesthesia, or surgery for my child as deemed necessary.
I also understand all reasonable safety precautions will be taken at all times by: Coach Earl and Coach Mike and their volunteers during the events and activities. I understand the possibility of unforeseen hazards and know there is the inherent possibility or risk. I agree not to hold, St. Augustine Catholic Church, its leaders, employees and volunteers liable for damages, losses, diseases, or injuries incurred by the subject of this form.
I also understand all reasonable safety precautions will be taken at all times by: Coach Earl and Coach Mike and their volunteers during the events and activities. I understand the possibility of unforeseen hazards and know there is the inherent possibility or risk. I agree not to hold, St. Augustine Catholic Church, its leaders, employees and volunteers liable for damages, losses, diseases, or injuries incurred by the subject of this form.
CONDUCT
I understand that by signing this form I/my child agree(s) to cooperate and participate fully, that I/my child will show respect for the property visited, respect for neighbor, that I/my child will show respect for the law and practice safety skills at all times. No guns or weapons will be allowed. By failing to meet this code of conduct, I/my child am/are aware that appropriate action may be taken and arrangements may be made for immediate removal from the event.
I understand that by signing this form I/my child agree(s) to cooperate and participate fully, that I/my child will show respect for the property visited, respect for neighbor, that I/my child will show respect for the law and practice safety skills at all times. No guns or weapons will be allowed. By failing to meet this code of conduct, I/my child am/are aware that appropriate action may be taken and arrangements may be made for immediate removal from the event.
PHOTO
I understand that by signing this form, I authorize the making of photographs, motion pictures, videotapes, voice recording, internet distribution or other memorializing of said event and my child’s participation therein, and the publication and duplication or other use thereof. I hereby waive any rights to compensation or any right that I otherwise might have to limit if to control such making or use.
I understand that by signing this form, I authorize the making of photographs, motion pictures, videotapes, voice recording, internet distribution or other memorializing of said event and my child’s participation therein, and the publication and duplication or other use thereof. I hereby waive any rights to compensation or any right that I otherwise might have to limit if to control such making or use.
