DAYTON CAMP 2019 APPLICATION

Please Print Team Camp High school teams can complete this application form with the team name and contact information. We understand camp payment is often made by various parties (per camper, booster club, parents, etc.). Please contact the UD Men’s Basketball office at (937) 229-4421 to register. The team camp and shooting clinic are open to all teams, only limited by number CAMPER NAME and will be held at the Frericks Center.

Waiver & Release: In consideration of participation in the Basketball camp as described herein, and having actual knowledge and appreciation of the particulars of the program and those risks ADDRESS involved in this type of activity/program, I, on behalf of my child, voluntarily consent to use of the facilities and participation in the activities/programs at this site, and assume all the risks arising therefrom. Each camper must be covered by his parent’s insurance before participating in any of the camp activities.

I hereby declare that my child is in good health and has no mental or physical condition or CITY STATE ZIP symptoms that could interfere with her/his safety or the safety of others while participating in any activity using any equipment or facilities of the University of Dayton. Furthermore, I certify that (s)he has adequate health insurance to cover any injury or damage that (s)he may suffer while participating, or alternatively, agree to bear all costs associated with any such injury or damages to her/him.

CURRENT AGE BIRTHDAY GRADE (entering in Fall) I, the undersigned, do hereby release, hold harmless, indemnify, waive, and discharge the University of Dayton and all its officers, agents, and employees from and against any and all claims, demands, actions or causes of action arising from any injuries or damages my child may suffer or sustain from her/his participation in, or use of, any facility, equipment, and/or programs. Furthermore, in full recognition and appreciation of the potential dangers and hazards inherent PARENT/GUARDIAN NAME(S) in athletic and other activities, I do hereby agree to assume any and all risks, liabilities, and responsibilities for all accidents, injuries, damages, or property losses arising from my child’s participation.

In the event of a medical emergency requiring more than basic first aid, I authorize University of Dayton to secure from any licensed hospital, physician, and/or medical personnel any treatment PARENT/GUARDIAN PHONE deemed necessary for my child’s immediate care and agree that I will be responsible for payment of any and all medical services rendered.

Parent/Guardian Name:

PARENT/GUARDIAN E-MAIL Parent/Guardian Signature:

T-SHIRT SIZE Phone: Day: Night: [ ] YS [ ] YM [ ] YL [ ] YXL Emergency Contact: [ ] S [ ] M [ ] L [ ] XL [ ] XXL

Emergency Contact Number: CHECK NO: Camper Health Form 2019 DAY CAMP SESSIONS To be completed and signed by a camper’s parents or legal guardian. First aid will be (check all that apply): available at camp throughout the week. [ ] Day Camp 1 - June 10-13 (Grades 2-9) Please check all that apply: [ ] Day Camp 2 - June 24-27 (Grades 2-9) [ ] Asthma [ ] Head Injury [ ] Bleeding Disorders [ ] Day Camp 3 - July 15-18 (Grades 2-7) [ ] Concussions [ ] Convulsions [ ] Seizures Cost: 1 session $235 (UD employees $210); 2 sessions $420; 3 [ ] Heart Disease [ ] Diabetes [ ] Other sessions $605 Allergies to Medications: 2019 JUNIOR FLYERS CAMP SESSIONS (check all that apply): Allergies to Food: [ ] Junior Flyers 1: June 21 (Ages 4-7) Last Tetanus Immunization (date): [ ] Junior Flyers 2: July 19 (Ages 4-7) Cost: 1 session $60 (UD employees $55); 2 sessions $100 Chronic or Recurring Illnesses: 2019 SHOOTING CLINIC Operations/Injuries (include date): 2019 DAYTON [ ] Shooting Clinic I: June 14 Physical Restrictions: (Grades 5-10) / Cost: $65 (UD employees $60) [ ] Shooting Clinic II: June 28 Phone: Physician: Dentist: (Grades 5-10) / Cost: $65 (UD employees $60) BASKETBALL CAMP Medical Insurance Provider: Policy Number:

PHOTO RELEASE - The Dayton Basketball camp may occasionally take pictures of our camp participants for use in its promotional/advertisement materials or publications (brochures, Team Camp: Please e-mail Andy Farrell at websites, newspaper ads, etc.). By signing this consent, I agree to allow the University of Dayton Division of Athletics to reproduce the likeness of my child in such promotional/ [email protected] for more information. advertisement materials or publications.

For additional information please call (937) 229-4421 or email [email protected] WELCOME TO THE DAYTON CAMP REGISTRATION DAY CAMPS The Day Camps will emphasize fundamental skill BASKETBALL CAMP! To register your son for the Dayton development. The daily program will feature individual Basketball Camp, please fill out the attention, small group instruction, contests and Welcome to a great registration form and return it with full competitions, including 5-on-5 play. This is a camper’s summer at the Dayton payment to the following address: unique opportunity to experience the University of Dayton Basketball Camp! Men’s Basketball program up close. 655 C Dayton Basketball Camp The Dayton Basketball University of Dayton Men’s Basketball Day Camp sessions will run from 9 a.m. to 4 p.m. Check in will begin on Monday at 8 a.m. 199 C Camp is meant to teach 300 College Park the fundamentals of the Dayton, OH 45469-1228 game and encourage a love and appreciation Full payment is due with the registration form. The fee for Day JUNIOR FLYERS CAMP for basketball and good Camps is $235 per session. Junior Flyers camp is $60 per Junior Flyers offers younger campers an opportunity to sportsmanship. We will session. The Shooting Clinic is $65. Please make checks payable experience Dayton basketball first hand. This one-day have a tremendous staff to the Dayton Basketball Camp. camp allows youngsters a preview of the Dayton Day Camp experience. Focusing on the fundamentals of basketball and of instructors which will An e-mail confirmation will be sent upon arrival of your having fun, this camp hopes to create a “passion to play” include the University in young players. Operated exclusively by the UD coaching registration form and payment. There is a $50 cancellation fee of Dayton coaches along staff, select players and support staff. prior to the start of camp and there are no refunds available for a with your favorite Flyer players. cancellation during the camp week. The camp will run from 9 a.m. to noon each session. If a camper signs up for multiple sessions, the additional Every participant can count on an exciting week of ONLINE REGISTRATION is also available. Anyone wishing to sessions will be discounted, but only one T-shirt will be competition and skill instruction. All registered campers register with a credit card for the Dayton Basketball Camp can distributed per camper. will receive a camp T-shirt. sign up through a safe and secure website. Please visit: www. DaytonFlyers.com/MBBCamps We hope you can join us! TEAM CAMP All University of Dayton camps and clinics are open to any and The team camp includes instruction from UD staffers, as well all entrants, and are only limited by the number, age, grade level, as team competition. High school teams (scholastic & non- or gender described. Due to the high volume of campers, we do scholastic) can complete this application form with the team CAMP INFORMATION not honor requests to group kids together on specific teams. name and contact information. However, we understand camp payment is often made by various parties (per camper, There are nine sessions of the Dayton Basketball Camp AVAILABLE DISCOUNTS booster club, parents, etc.). for boys this summer. Grades listed below are for the Please contact the UD Men’s Basketball office at (937) 229- 2018-19 school year. Several discounts are available this summer for the Dayton 4421 for more information on the team camp to help with Basketball Camp. Only one (1) discount may be applied per payment and registration logistics (camper names, etc.). The • Day Camp 1 - June 10-13 (Grades 2-9) camper. camp is open to all teams, only limited by number. Team • Shooting Clinic 1 - June 14 (Grades 5-10) Camp sessions will take place at UD Arena and RecPlex. • Junior Flyers 1 - June 21 (Ages 4-7) • Families with three or more kids who attend the same Day • Shooting Clinic 2 - June 28 (Grades 5-10) Camp session will receive a $25 per child discount. • Day Camp 2 - June 24-27 (Grades 2-9) • If the same child attends more than one Day Camp, there is a SHOOTING CLINIC • Day Camp 3 - July 15-18 (Grades 2-7) $50 discount for each Day Camp attended after the first one is If you are looking to become a great shooter, this is the • Junior Flyers 2 - July 19 (Ages 4-7) paid in full. camp for you. This clinic will emphasize proper shooting • UD employee discounts: $25 for the day camp and $5 for mechanics and teach campers a variety of drills that they Junior Flyers and the Shooting Clinic. can use to improve this facet of their game. Campers will The camps will begin and end at the Frericks Center each • If the same child attends two Junior Flyers camps, the cost is $100. learn how to develop a shooting program routine that is day. The Frericks Center is located on the University similar to what the use as part of their skill development program. of Dayton campus. A certified athletic trainer will be LUNCH & CAMP STORE available at every session to provide medical assistance if The one-day clinic will run from 9 a.m. to noon. needed. For the Day Camps, campers may bring their own lunch or purchase pizza in the morning before each session begins. Campers will be able to purchase drinks and snacks from the For information on all camps: camp store along with Dayton Flyer Basketball gear. $10 punch cards will be available for sale on the first day of camp so Call: (937) 229-4421 campers will not need to hold onto cash during the sessions. Email: [email protected] Pizza and punch cards only apply to the Day Camps. The Camp Visit: DaytonFlyers.com/MBBCamps Store, however, will be open for all camps.