KIRKSVILLE BOYS BASKETBALL CAMP 2013 When: May 28th-May 31st Where: High School Gym

Grades: 4-12 Camp Staff will be Coaching Staff/Former Players (Alumni) (Grades for 2013-14 school year)

TIMES: (Grades for 2013-14 school year) 8:00 - 9:30 AM (students entering) GRADES 4h-6th 10:00 - 11:30 AM (students entering) GRADES 7th-8th 1:00 - 2:30 PM (students entering) Grades 9th-12th

(ONLY PLAYERS INTERESTED IN PLAYING HS BASKETBALL 9-12) *CAMP IS OPEN TO ALL PLAYERS, NOT JUST KIDS FROM KIRKSVILLE. HOWEVER, IF YOU ARE GOING TO BE A FRESHMAN DURING THE 2013-14 SCHOOL YEAR, YOU MUST BE ATTENDING KIRKSVILLE SR. HIGH. *PRE-REGISTERED CAMPERS WILL RECEIVE A CAMP T-SHIRT (May 10th 2013) (IF YOU ARE NOT PRE-REGISTERED, YOU WILL NOT RECEIVE A T-SHIRT!) FORMS AVAILABLE AT THE KHS OFFICE OR ONLINE @ http://www.kirksville.k12.mo.us (click on high school page, athletics, then basketball)

PRE-REGISTERED COST: $35.00 ($30.00 FOR EACH SIBLING) ON-SITE REGISTRATION: $40.00 ($35.00 FOR EACH SIBLING)

No Refunds Once Paid(Call/Email Special Circumstances) Pay with Cash or Check: PLEASE MAKE CHECKS PAYABLE TO KIRKSVILLE R-III School District (Memo Boys Basketball Camp) FORMS CAN BE DROPPED OFF TO THE HIGH SCHOOL OR MAILED TO COACH Martin: Tyler Martin 1202 East Jefferson KIRKSVILLE, MO 63501 ** CAMPER INFORMATION** NAME: _________________________ GRADE FOR 2013-14: __________ AGE: _____ BIRTHDATE: __________ POSITION(S): ______________________ ADDRESS: _____________________ CITY: _________________ ZIP: _______ HOME PHONE #: __________________ EMERGENCY #: _____________________ SHIRT/SHORT SIZE (circle): Youth: 10-12 14-16 Adult: S M L XL XXL (When in doubt on sizes, order a size too big as we do not order extra shirts!) **Identification and Medical Treatment Authorization** The undersigned parents and/or guardians of (campers name) ____________________, the applicant, for and in further consideration of the basketball camp acceptation said applicant, does hereby release and discharge Kirksville R-III Schools and its representatives, employees, and agents from any and all debts, claims, demands, actions, damages, caused of action, judgments, or suits of any kind which may arise or be occasioned as a result of any course of instruction or the applicants participation in the basketball camp. In addition, I/we being the parents and/or guardians of the applicant authorize the Kirksville R-III and its agents permission to request emergency medical treatment or care as necessary to insure the well being of our dependent. Further, I claim the registrant has had a physical examination in the past year and was found fit for all physical endeavors. Signature of Parent or Guardian: _________________________ Date: ____________________ Family Health Insurance Provider: ____________________________________________________ Family Health Insurance Policy #: _____________________________________________________ **Camper Code of Conduct Contract** As a participant in the Kirksville Tiger Basketball Camp, I agree to comply with all of the rules, regulations, and directives of the coaching staff, and I will treat all of the coaching staff and other camp participants with respect, courtesy, and good will. I have read the above statement and understand that failure to comply with that statement may result in my removal from the camp without refund. Participants Signature: _________________________ Date: _______________________

Read more here:
Sign up for Kirksville boys basketball camp