Culver-Stockton College

Welcome to Culver-Stockton College Women's Basketball Jr. Wildcat Club

Grades 1 - 6

The Culver-Stockton College Women's Basketball team would like to invite you to join the Jr. Wildcat Club for basketball, fun, and friends.  

This is a great opportunity for students full of games, contests, and prizes.

Members will receive:

• Free Game Day Admission For Member And One Guardian
• One Hour Clinics Given Monthly
• T-Shirt
• Be A Part Of Wildcats Game Day (Towel kids, Water kids, Ball kids,
  etc.)
• Reserved Seating
• One Free Popcorn on Wednesday Games
• Newsletter
• So much more

For more information please contact, Janette Burgin, Head Coach at jburgin@culver.edu or Megan Diehl, Graduate Assistant at mdiehl@culver.edu 

When you click the submit button on this form, it will direct you to the credit card site to enter your payment information.  Jr. Wildcat Club applicants may be completing this form in a school setting and not have access to credit card information at that time. To avoid duplication of camp applications, please answer No and return to the form at a later time to complete your application.  Thank you.

Click the link to download the 2024 Jr. Wildcat Club brochure

Student Name:

Last Name:

First Name:

Enter your home address information:

Street Address:

City:

State:

Zip Code:

Contact Information:

Telephone #:

Emergency Phone #:

Parents Email:

Additional Information:

Please select the Grade you are in this year:

T-Shirt Size:

Insurance Company:

Insurance Company:

Policy Number:

Youth may receive snacks.

List any Food Allergies (if applicable):

Signature and Release

The following statement must be signed by the parent/guardian of the camper.  By typing your name in the field below, you acknowledge that the form is complete/accurate and you are certifying your understanding of the statements below.  Furthermore you agree your name in the box constitutes an electronic signature authorizing the college to take action in the event of an emergency.

Statement:

I hereby release Culver-Stockton College and its employees from all claims on account of any injury which may be sustained by my child as a result of participating in the Culver-Stockton Women's Basketball Jr. Wildcat Club.

Furthermore, in the event of illness or injury, I hereby give consent for medical treatment and permission to the attending physician to hospitalize, secure proper treatment, and order injections, anesthesia, or surgery.

It is further understood that if an accident occurs, the parents primary insurance will provide the necessary care.

Name of Participant:

Age of Participant:

Parent/Guardian Signature:

Submission Date:

Thank you for completing the Women's Basketball Jr. Wildcat Club Application.  Your application will not be complete until a successful deposit payment has been made.  Please click the button below to secure a spot in the camp.  Failure to complete the online deposit payment will nullify this application.  Any questions, please contact the C-SC Athletic Office.