Carlisle Girls Basketball Youth Summer Camper Registration

INFORMATION FOR CAMP:

Camp runs Monday, June 16th - Thursday, June 19th from 5:00 - 8:00 PM at Gene Evan’s Gym (Carlisle HS)
Rising 3rd - 8th graders
$75 per camper
All campers registered by June 1st receive a t-shirt
First 50 registered campers are guaranteed to take home a basketball
Drop off camp - no room for parents to stay and watch
Coach Kelsey Stasyszyn will send an e-mail closer to camp with more information

Camper First Name

Camper Last Name

Grade in Fall 2025

T-Shirt Size

Camper Current School

Address

Parent/Guardian Name

Parent/Guardian Phone Number

Parent/Guardian E-mail

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone Number

Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the athlete prescribed an inhaler?

Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by Kelsey Stasyszyn and Carlisle Girls Basketball during the selected camp. In exchange for the acceptance of said child’s candidacy by Kelsey Stasyszyn and Carlisle Girls Basketball, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Kelsey Stasyszyn and Carlisle Girls Basketball and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions. In case of injury to said child, I hereby waive all claims against Kelsey Stasyszyn and Carlisle Girls Basketball including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Parent/Guardian Signature

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Campers will have the opportunity to work with the Carlisle Girls Basketball players and staff. Campers will work on skill development, fundamentals of the game and participate in fun competitions.

June 16 - 19

5:00 - 8:00 PM

Girls grades 3rd - 8th

$75