Culver-Stockton College

Welcome to Culver-Stockton College Men's Youth Basketball Camp Application

Grades 1-8

July 28-30th

Dear Campers and Parents,

The Culver-Stockton College Men's Basketball team would like to invite you to three days filled with basketball, fun, and friends.  

The camp will be run by the men's basketball coaches and Wildcat players.

This is a great opportunity for players to work with a college coaching staff and for players to help build proper fundamentals and become a better basketball player.  We look forward to meeting and working with you at our upcoming skills camp.

When you click the submit button on this form, it will direct you to the credit card site to enter your payment information.  Camp 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.

Youth Camp Goal:

Camper Name:

Last Name:

First Name:

Enter your home address information:

Street Address:

City:

State:

Zip Code:

Contact Information:

Telephone #:

Emergency Phone #:

Campers E-mail:

Parents Email:

Additional Information:

Days Attending:

Please select the Grade you will be entering next year:

Name of School where you attend:

T-Shirt Size:

Insurance Company:

Insurance Company:

Policy Number:

Please list any medical history we need to know about (asthma, heart condition, etc.)

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 Men's Basketball Camp.

Furthermore, I certify that within the past year my child has had a physical examination and that she/her is physically able to participate in basketball activities.  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 parent's primary insurance will provide the necessary care.

Name of Participant:

Age of Participant:

Parent/Guardian Signature:

Submission Date:

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

REMEMBER in order for your place to be secured in the Summer Camp you must complete registration and payment.