Camp Registration Form Camper’s Consent Form Please Print Must be filled out and returned for camp attendance Camper’s Name: _ Name of Camper: _ Parent(s) Name: Allergic Reactions (asthmas etc.) Yes No If yes, please describe: _ Address: _ City/State/Zip: _ In Case of Emergency: Home Phone: FATHER: _ Cell Phone: Elmhurst College 2019 Girl’s Basketball Camp I-June 17th-20th II-July 29th-Aug 1st Home phone: ( ) _ Work phone: ( ) _ Parent’s E-Mail: _ Age at start of Camp: Youth T-Shirt Size: _ S M LG MOTHER: Home phone: ( ) _ Adult: S M Birthday: _/ _/ _ Mark which session you are planning on attending: _ June 17th-20th _ July 29th-Aug 1st *If you are attending both sessions the total would be $300 ($50 discount for attending both sessions) *If you are attending only a single session your total would be $175.00 Mail Registration to: Tethnie Carrillo Elmhurst College Basketball Camp 190 Prospect Avenue Elmhurst, IL 60126 Make Check Payable to: CT Sports LG Work phone: ( ) _ I, the undersigned, herby certify that I am the legal guardian of the camper I hereby give my permission for the staff of Elmhurst College Basketball during the duration of the camp, to seek appropriate medical attention for the camper, for medical attention to be given and for the camper to receive medical attention in the event of accident, injury or illness I will be responsible for any and all costs of medical attention and treatment and have medical insurance to cover these costs I, the undersigned, for myself and as a guardian of above named camper, understand that basketball is an active, physical sport, and that injuries can take place during play I also understand that there will be a number of other campers attending the camp, there will be a limited number of staff and that our child cannot receive individualized attention and supervision all of the time I understand that, as with any sport, injuries can occur, and we hereby acknowledge that our child is physically fit and mentally capable of participating in camp activities I, the undersigned for myself, my heirs, executors and administrators, waive, release and forever discharge Elmhurst College Basketball, Elmhurst College, and its staff, officers, agents, representatives, successors, and assign of and from all rights and claims for damages, injury or loss to person or property which may be sustained or occur during participation in camp activities or while at the camp, whether or not damages, injury or loss due to negligence Signature of Parent/Guardian: _ "Distribution of information by a community group in accordance with District 97 policy does not imply, directly or indirectly, that the group's program(s), event(s) and/or service(s) is sanctioned, sponsored or endorsed by the district, the Board of Education or the superintendent." Monday-Thursday 8:30 AM-12:00 PM KDG-5th Grade www.elmhurstwbbcamps.com Camp Staff Tethnie Carrillo 11th year Head Coach Most wins in programs history Two All-American Two CCIW Player of the Years 16 CCIW All Conference Selections Played at D2 Emporia State University Taught PE in Evanston and River Forest Kim Schwerdtmann 2nd Grade Teacher at Edison Elementary School in Elmhurst Played College Basketball at Elmhurst College Camp Counselors Camp Counselors will consists of head college coaches, high school coaches and local Elmhurst College Women’s Basketball Players Camp Goal The goal of the camp is to create an entertaining environment for girls to learn the game of basketball We will focus on the fundamentals of the game both on the offensive and defensive end Campers will receive excellent coaching and develop friendships with their fellow campers Camp Cost Camp fee is $175 That includes camp t-shirt, basketball and camp awards Camp Location All sessions will be held in the Elmhurst College Gymnasium, R.A Faganel Hall, located at 221 Walter Street in Elmhurst Directions available at www.elmhurst.edu Camp Format *Individual skill work *Offensive and defensive concepts *Skill Contests *Competitive Games How to Register Online at either: www.elmhurtswbbcamps.com or www.elmhurstbluejays.com/camps Mail in: Mail in your registration form and check or money order for $175 to Tethnie Carrillo, Women’s Basketball, 190 Prospect Ave, Elmhurst, IL 60126 Make checks payable to “CT Sports.” If you have any questions please call 630-617-3144 or e-mail your questions to Coach Carrillo at carrillot@elmhurst.edu ... coaching and develop friendships with their fellow campers Camp Cost Camp fee is $175 That includes camp t-shirt, basketball and camp awards Camp Location All sessions will be held in the Elmhurst... College Basketball at Elmhurst College Camp Counselors Camp Counselors will consists of head college coaches, high school coaches and local Elmhurst College Women’s Basketball Players Camp Goal... goal of the camp is to create an entertaining environment for girls to learn the game of basketball We will focus on the fundamentals of the game both on the offensive and defensive end Campers will