CLACKAMAS CAGE CAMPS

COMPETIVE EDGE BASKETBALL EASTSIDE

SUMMER 2015
Shooting and Position clinics for all boys and girls.
You can choice to attend all six sessions or pick
individual sessions you want to attend.
WEBSITE:

clackamascagecamps.net
competitiveedgebasketballeastside.net

LOCATION: Clackamas High School

Clinic Dates and Times

JUNE 15TH
Shooting Clinic from 12:00 pm to 1:30 pm
Position Clinic from 1:30 pm to 3:00 pm
JUNE 22ND
Shooting Clinic from 8:00 am to 9:30 am
Position Clinic from 9:30 am to 11:00 am
JUNE 27TH
Shooting Clinic from 8:00 am to 9:30 am
Position Clinic from 9:30 am to 11:00 am
Cost for Clinics
ACADEMY COST:
$25 per individual session.
$140 for all six sessions

2015 Registration Form

Please send registration and release form to:
STEVEN GUSTOVICH
PO BOX 482
OREGON CITY, OR 97045

Attending all six sessions

Attending shooting clinics-

Cost $140
Cost $25 per session

June 15th
June 22nd
June 27th

Attending position clinics-

June 15th

June 27th

Cost $25 per session

June 22nd

ATHLETES NAME __________________________________________________________

EMERGENCY PHONE NUMBER _________________________________
EMAIL FOR FUTURE CLINICS __________________________________________

ATHLETES RELEASE FORM

I, (Parent or
Legal Guardian)___________________________________________________________,
authorize all medical, surgical, diagnostic and hospital procedures as may be performed
or prescribed by a physician for
(Athletes Name)_______________________________________,
If I cannot be reached in case of an emergency.

Date _____________________________

Signature______________________________________________ (Parent or Legal Guardian)

I herby grant permission to the Clackamas Cage Camps to have my son/daughter
treated by a physician if necessary. He/She is physically fit according to our family
physician, and I acknowledge that I am responsible for any and all medical expenses due
to my childs illness or injury.

ATHLETES MEDICAL INFORMATION

Birthday ___________ Last Tetanus Shot _________
Allergies______________________________________
Chronic Conditions (i.e. Asthma) _______________
_______________________________________________
Regular Medication ____________________________
Athletes Physician_____________________________
Physicians Phone # ___________________________
Medical Insurance Carrier______________________
Insured________________________________________

AMATEUR ATHLETIC MINOR WAIVER & RELEASE LIABILITY

Participant represents to the Clackamas Cage Camp that Participant is in physically sound
condition and has no disability, illness or other condition preventing participant form engaging or
otherwise participating in basketball. Participant understands and acknowledges that participation
in basketball involves or otherwise includes risk of injury, including but not limited to knee and
ankle injury, muscle strain and pull, shin splint and over exercising.