Rodney Monroe Holiday Basketball Camp

Emergency contact name: **Note: Fee must accompany ______________________________ SouthLake Registration form to be accepted** ______________________________ Relationship: ___________________ Christian Emergency contact phone: Program for which you are registering: ________________________ Academy __________________________________ Other phone: ___________________ Name of Alternate emergency contact name: participant(s):_______________________ ______________________________ Presents… __________________________________ ______________________________ Address: Relationship: ___________________ __________________________________ Physician’s name: ________________________ __________________________________ City__________________ Zip_________ Physician’s phone: ______________________ Date of Birth(s):_______________________ Insurance carrier: Grade in school: _______________ ________________________ Age(s):_______________________ Policy/Group Gender: __________ #:_____________________________ Home Phone: ______________________________ ________________________ Other Phone: Shirt Size: ________________________ (Youth) S M L XL Rodney Monroe Parent/Guardian: (Adult) S M L XL 2XL __________________________________ Holiday ___________ Make check payable to: Rodney Monroe Email: ________________________ Basketball Relationship to participant: Basketball Camp ____________________ Mail registration and check to: Daytime phone: P.O. Box 1247, Huntersville, NC 28070 ________________________ December 18-22, For more information call or email *Please list any allergies (drugs, plants, Rodney Monroe at (561) 707-7611 2017 animals, etc.), medical conditions, Email: [email protected] restrictions or necessary special Visit my website at: accommodations which the instructor or Ages 6-9, 9am-12pm director should be aware of: RodneyMonroeBasketball.com __________________________________ DenverBasketballLeague.com __________________________________ Ages 10-14, 1pm-4pm __________________________________ **Camp will be held at: __________________________________ SouthLake Christian Academy _______________________________ 13820 Hagers Ferry Road $125/child or Huntersville, NC 28078 $225/two children Parental/Participant Consent Release DAILY ACTIVITIES and Waiver I (or my child/children) am voluntarily A typical day at camp participating in the program, class or consists of the following: event specified. In return for the opportunity to participate, I voluntarily for myself (or child/children) waive, release, indemnify and hold harmless the Rodney Monroe Basketball Camp, Stretching its employees, and sponsors from any liabilities, claims, damages, injuries, Rodney graduated high school as the losses, and expenses including state of Maryland’s all-time leading reasonable attorneys fees and costs scorer with over 3,000 points. He whatsoever, including those for personal earned a scholarship to North Ball Handling Skills injury, death, or property damage, which Carolina State University, and holds may arise from or in connection with several records including all-time participation in this program, class or leading scorer. He was ACC Player event. of the year in 1991. He broke David Thompson’s school scoring record at Defensive Principals If this registration is for one of my minor NC State, and he’s fifth on the ACC’s children, I herby consent to emergency all-time scoring list with 2,551 career treatment and transportation of my points. In 2002 Rodney was named minor child for any condition that may th to the ACC 50 Anniversary men’s arise from or in connection with basketball team as one of the fifty Shooting Principals participation in the program, class or greatest players in Atlantic Coast event and I shall be responsible for the Conference history. “Fire and Ice” payment of all costs associated with was the popular nickname given to such emergency treatment or Monroe and backcourt teammate transportation. Chris Corchiani during their years with the Wolfpack. This year Rodney Passing I agree to abide by all Town ordinances was honored as an ACC Basketball and school rules and regulations ad Legend. He was drafted by the understand that the Rodney Monroe Atlanta Hawks and played Basketball has the right to close professionally in Europe 14 seasons. registrations and to change fees and Rebounding/blocking out requirements when necessary. This He has brought his knowledge of the release shall remain in effect until game and desire to work with kids cancelled in writing. together to create an excellent camp that all participants will enjoy. Join _______________________ ________ him as he brings his talent to the Fun and Games area. Sign up before it’s too late! Parent/Guardian Signature Date .

Load more