1000 SHOT CAMPOPEN TO ANY AND ALL

BOYS GRADES 3-12 JUNE 24-26 • 9 a.m. to Noon

The goal of the 1000 shot camp is to make the camper a better shooter through technique, instruction, and repetition.

1000 SHOT CAMP REGISTRATION: Registration will be Monday, June 24 at 8:15 a.m. in LANTZ ARENA.

CAMP COSTS: $85 and includes a t-shirt.

LITTLE PANTHER CAMPOPEN TO ANY AND ALL

BOYS & GIRLS GRADES K-2 JUNE 24-26 • 9 a.m. to Noon

The goal of this camp is to help players improve on their fundamental skills.

Campers will enhance their shooting, passing, rebounding and defensive skills

in a fun, instructional atmosphere.

PANTHER DAY CAMP REGISTRATION: Registration will be Monday, June 24 at 12:30 p.m. in LANTZ ARENA.

CAMP COSTS: $85 and includes a t-shirt.

CAMPERS ARE ENCOURAGED TO SIGN UP FOR BOTH 1000 SHOT & PANTHER DAY CAMPS - BRING A SACK LUNCH or

PURCHASE LUNCH ON CAMPUS.

PANTHER DAY CAMPOPEN TO ANY AND ALL

BOYS GRADES 3-12JUNE 24-26 • 1 to 4 p.m.

Emphasis is on basic fundamentals of shoot-ing, dribbling, passing, rebounding, footwork, and defense. This will be implemented in a fun environment that will include games and contests.

LITTLE PANTHER CAMP REGISTRATION: Registration will be Monday, June 24 at 8:15 a.m. in LANTZ ARENA.

CAMP COSTS: $85 and includes a t-shirt.

CAMP(S) WILL BE CONDUCTED IN AIR CONDITIONED FACILITIES...LANTZ ARENA AND EIU STUDENT RECREATION CENTER

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BASKETBALLCAMPS

JUNE 24-26OPEN TO ANY AND ALLLITTLE PANTHER CAMPboys & girls- grades k-2

1000 SHOT CAMPboys grades 3-12 (9am-Noon)PANTHER DAY CAMPboys grades 3-12 (1-4 pm)

2019 SUMMER CAMPS

HEALTH & CONSENT FORMThis medical treatment and billing authorization form must be completed andsigned by the parent to enable the camper to participate.

Camp Attending ________________________ Camp Code ________

Camper Name _______________________ Age ____ Gender ____

Address __________________________________________________

City / State / Zip __________________________________________

EMERGENCY CONTACT INfORMATIONParent / Guardian ___________________ Relationship ____________

Home Phone ____________________ Work Phone _______________

Emergency Contact _________________ Relationship ____________

Home Phone _________________ Work Phone _________________

HEALTH INfORMATIONdoes camper have a history of:

___ Convulsions ___ Heart Defect/Murmur ___ Asthma ___ Chicken Pox ___ Diabetes ___ Bleeding Disorder ___ Surgery (past 2 years) ___ Mumps

Brief description of items checked ___________________________

_________________________________________________________

Medications: Type, dosage and frequency (list) _________________

_________________________________________________________

Allergies: (medications, foods, stings, other) ___________________

_________________________________________________________

INSURANCE INfORMATION

eAsteRn iLLinOis uniVeRsitY ReQuiRes that all sports campers carry health insurance coverage. The parent/guardian’s personal or injury insurance policy will be utilized as the primary insurance for the treatment of injuries and hospitalization forillness or injuries incurred during the sports camps. if you do not possess healthcoverage, a temporary policy covering sports camps must be purchased(through your insurance agent) to cover the camper for the duration of the sportscamp. the name of health insurance carrier and policy number must be writtenbelow in order to attend an eiu sports camp.

Insurance Carrier Name _____________________________________

Carrier Address / Phone _____________________________________

Policy / Group Number ______________________________________

AutHORiZAtiOn FOR tReAtment: I do hereby authorize Eastern’s athletictraining staff to provide first aid, follow-up care and/or referral to Eastern’s HealthService Staff, local physician or local hospital for emergency care. Furthermore,I hereby authorize EIU Health Service Staff to provide medical treatment and/orreferral for further evaluation and treatment for the above named person in the eventthis should become necessary while attending camp at Eastern Illinois University.

_______________________________________________________Signature of Parent / Guardian (required for participation) Date

Athletes must come to the Panther Camps physically sound. no preventative taping will be administered for injuries received prior to camp.

EIU PANTHER SPORTS CAMP INFOfACILITIES: The basketball camp will be held on the campus of Eastern Illinois University in Charleston, Illinois. Camp will be held in air conditioned Lantz Arena or the Student Recreation Center.

SUPERVISION and SECURITY: Adult supervision is pro-vided and includes the following: campus security provided by the EIU Police Department, access to medical attention, certified athletic trainers.

CAMP REGULATIONS: Good conduct is expected of all basketball camp participants with respect to social and moral responsibilities. General training rules will be in effect for all campers. Any breach in good conduct or training rules (as judged by the sports camp staff) will result in immedi-ate expulsion from camp. Parent/guardian will be notified and are responsible for providing transportation to return the camper home. After on-campus registration has been completed, there will be NO REfUNDS for early withdrawals or disciplinary dismissals.

PHONE CONTACT:(501) 499.1694 - Men’s Basketball Office

EMAIL US: acboyle@eiu.eduON THE WEB: www.eiupanthers.com

REGISTRATION FORM

As parent/guardian, I have read and hereby accept the conditions

described in this brochure. I also understand that eiu Panther sports

Cam

ps retains the rights to use photographs of campers taken at cam

p for publicity and/or advertising purposes.

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CHECK CAMP(S) ATTENDING:

JUNE 24-26, 2019: BOYS & GIRLSLITTLE PANTHER CAM

P ... GRADES K-2

$85 (code ... BBLP)SIGN UP fOR BOTH CAM

PS!!!BOYS 1000 SHOT CAM

P ... GRADES 3-12 $85 (code ... BB1000)

BOYS PANTHER DAY CAMP ...

GRADES 3-12$85 (code ... BBD)

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Cancellations made prior to on-campus reg-istration may receive a refund, less $50.00, by submitting a request (in writing) to the athletic office within 30 days after the first camp day.

After on-campus registration has been completed, there will be NO REfUNDS for early withdrawals or disciplinary dismissals.

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See you this summer!

HEALTH and INSURANCE: Each applicant must have a Health & Consent form signed by a parent/guardian, stating camper is in good health and who to contact in case of an emergency. This form is included in this brochure. Form is also available online at our summer camp link at www.eiupanthers.com. This form must be completely filled out, signed and returned to us, along with application.

EIU requires that all sports campers carry health insur-ance coverage. The parent/guardian’s personal or injury insurance policy will be utilized as the primary insurance for the treatment of injuries and hospitalization for illness or injuries incurred during the sports camps. The name of health insurance carrier (and policy number) must be written on the Health & Consent form in order to attend an EIU sports camp.

If you do not possess health coverage, or are self-insured, a temporary policy MUST be purchased (through your insurance agent) to cover the camper for the duration of the sports camps.RESERVE YOUR SPOT NOW!

LIMITED ENROLLMENT: The sports camp size is limited to allow the best possible experience. We urge you to send in your application early.

WWW.EIUPANTHERS.COM