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CI's Basketball Camps 2023
Child's Name___________________________________ Phone________________________ Address_________________________________ City______________ State___ Zip_______ Age_______ Shirt Size (circle) S M L XL Grade you will be September 2023_________ Email Address_____________________________ Check Session: Session I (June 26-June 30) ___ Session II (July 10-14) ___ Cost is $160.00 per Session. Registration: Complete the registration form and return it with a $50.00 nonrefundable deposit. The remaining $110.00 can be paid at registration on the first day of camp. No confirmations will be sent out. For more information contact Ron Insinger at 570-326-3581 (W) or 570-337-0676 (C). checks payable to Ron Insinger. Parental Permission & Medical Release Form: I request that you accept the application of my son/daughter for the 2023 camp at Loyalsock. I hereby release Loyalsock School District and the Ron Insinger (CI) Basketball Camp from all claims due to any injuries, medical, dental or any other loss of personal property. My son/daughter___________________ is covered by a personal insurance policy, or is included in my program. I hereby authorize routine medical care for my child and I authorize treatment not considered routine to be referred to local physicians at my expense. Parent's Name______________________________ Date_______________ Parent's Signature_________________________ Emergency Phone_______________ Send application with payment to: Ron Insinger For more information please visit www.cisbasketballcamps.com Camps are held at the Loyalsock Middle and High School Gyms |