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_________
Session I (June 24-June 28) ___ Session II (July 8 - 12) ___
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:
For more information please visit www.cisbasketballcamps.com
Camps are held at the Loyalsock Middle and High School Gyms
By Calypso Media Group