CI's Basketball Camps 2019

 

Child's Name___________________________________  Phone________________________

Address_________________________________ City______________  State___  Zip_______

Age_______   Shirt Size (circle)  S    M    L    XL      Grade you will be September 2019_________

Email Address_____________________________

Check Session:

Session I (June 24-June 28)    ___     Session II (July 8 - 12)       ___      
Session III (July 22-26)  ___             Session IV (July 29-Aug 2)        ___        

Cost is $125.00 per Session.

Registration: Complete the registration form and return it with a $50.00 nonrefundable deposit.  The remaining $75.00 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 2019 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
Loyalsock High School
1801 Loyalsock Drive
Williamsport, PA 17701

For more information please visit www.cisbasketballcamps.com

Camps are held at the Loyalsock Middle and High School Gyms

By Calypso Media Group