Lee College Center for Workforce and Community Development Permission/Emergency Registration FormThis form must be completed, including the parent or legal guardian signature for students 17 years or younger.Registration forms must be submitted to the CWCD O� ce in person, by mail, or fax.

Student Information (please print all information)

Last Name First Name M.I.

Address City State Zip

Primary Phone Birthdate Entering Grade q Maleq Female

SSN# Email Address

Does this child have any disabilities, present injuries, allergies, hemophilia, heart conditions, history of respiratory illness, or any other signi� cant medical condition? q Yes q No If yes, please state: _______________________________________________________________

Parent/Guardian: ________________________________ 2nd Contact (relationship): __________________________

Home/Cell Phone: ______________ Home/Cell Phone: ______________

Work Phone: ___________________________________ Work Phone: ___________________________________

Employer: _____________________________________ Employer: _____________________________________

If I cannot be reached, please contact the person listed below:Full Name (family, friend): ___________________________ Phone: _______________________

In case of emergency, I hereby authorize treatment and/or care as deemed necessary by the Lee College sta� .Doctor’s Name: __________________________________ Phone: _______________________

Parent or Guardian’s Signature Date

PO Box 818, Baytow

n, Texas 77522-0818

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LEE CO

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Baytown, TX

Permit N

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Model Release: I q do q do not (check one) grant Lee College permission to use my name/child’s name, photograph, and comments for marketing, advertising, college relations, and promotional purposes. I understand I will not be paid for any use of my image in any Lee College marketing materials now or in the future.

Non-Release of Directory Information: I q do q do not (check one) grant Lee College permission to release Directory information to the general public without written consent. Directory items include the student’s name, address, major, activities participated in, dates of attendance, and degrees and awards received.

Session: q Girls K - 4th grades q Girls 5th - 10th grades q Boys K - 4th grades q Boys 5th - 10th grades q Shooting Camp

GRADES K - 12(COED)

For O� ce Use Only

Student I.D. Receipt # Date Initials q RD q FERPA

CAMP REGISTRATION STARTS MAY 1, 2018Due to the overwhelming response from last year’s camp, only a limited number of applications per session will be accepted. Each session will be on a � rst-come, � rst-served basis

TYPICAL CAMP DAY08:00 – 08:15 Warm up, stretching, and easy running08:15 – 08:30 Pistol Pete ball-handling routine08:30 – 09:40 Station work09:40 – 10:00 Break time10:10 – 10:15 Mikan layups10:15 – 10:40 Hot shot shooting competition10:40 – 11:00 Freethrow shooting11:00 – 12:00 Lunch (bring money or a lunch)12:00 – 01:00 3-on-3 games

COSTAll camps are $95 per person(Fee includes camp basketball and t-shirt.)

Discounts for children in the same family. First child pays $95. Each additional family member (brother or sister) pays $50.

CAMP FEATURES § Air-conditioned arena § Camp t-shirt § Motivational booklet § Daily refreshments § Special guest speakers § Enthusiasm § Family atmosphere § Certi� ed licensed trainer § Camp basketball § Camp certi� cate

FACILITIESAll camps will be conducted in the Lee College Sports Arena. The arena was built in 2003 and has the capacity to seat 1,500 screaming fans. The arena also boasts a wellness center, multiple locker rooms, a training room, film room, and two regulation basketball courts.

EQUIPMENTCampers should report each day wearing basketball shoes, athletic socks, shorts, and camp t-shirt. No caps, watches, or jewelry will be permitted, PLEASE!

GIRLS K - 5THJULY 9- 13174KAC10011M-Th 8:00 a.m. - 1:00 p.m.F 8:00 a.m. - 12:00 p.m.

GIRLS 6TH - 12THJULY 16 - 20174KAC10013M-Th 8:00 a.m. - 1:00 p.m.F 8:00 a.m. - 12:00 p.m.

BOYS K - 4THJULY 23 - 27174KAC10014M-Th 8:00 a.m. - 1:00 p.m.F 8:00 a.m. - 12:00 p.m.

BOYS 5TH - 10THJULY 30 - AUG. 3174KAC10015M-Th 8:00 a.m. - 1:00 p.m.F 8:00 a.m. - 12:00 p.m.

CAMP AWARDSAn awards ceremony will conclude each week of camp. The ceremony will be conducted at 11:50 each week with awards for each age group for the following categories:

In addition, every camper will receive a certi� cate of merit for participation in the camp.

CAMP GOALS § Each camper will leave with a positive attitude. § Each camper will leave the camp closer to reaching their full

potential on the basketball court. § Each camper will learn the proper fundamentals and develop the

con� dence in their abilities so they can utilize the skills they learned in the camp.

§ Each camper will learn how to appreciate and love the game of basketball.

§ Each camper will be exposed on how to conduct themselves on and o� the court through sportsmanship, competition, and learning how to deal with winning and losing.

§ Each camper will learn that to be successful they will need to � nd the dedication, desire, and discipline to be successful in basketball and, most importantly, in life.

CAMP STOREThe camp store will be open for business each day after camp concludes. Runnin’ Rebel merchandise and other items will be available for purchase. Lee College will provide a camp bank so campers can store their money without the fear of losing or misplacing it.

§ Mikan layups § Hot shot shooting

§ Freethrow shooting § 3-on-3 competition

SUMMER CAMP

SHOOTING CAMP JUNE 26 – 28(Coed 7th - 12th grades) 174KAC10012Tues. 1:00 p.m. - 4:00 p.m.Wed.-Thur. 9:00 a.m. - 12:00 p.m., 1:00 p.m. - 4:00 p.m.

BASKETBALL WAYS TO REGISTERIn person: 909 Decker Drive, Baytown, TX

Fax: 281.425.6855 (Visa, MC, Discover, AMEX)

By Mail: Lee College Lee College Center for Workforce and Community Development (CWCD) P.O. Box 818 Baytown, TX 77522-0818

Online: www.lee.edu/workforce

For more information call 281.425.6311

Choose Payment Type:

q Cash q Check q Visa q MC q Discover q AMEX

_______________________________________Card Number

_______________________ ______________ Exp. Date CVV Code

_______________________________________Print Cardholder Name

Please make all checks payable to Lee College.

Check #__________ TDL #_____________________

Exp. Date __________________

Registration fees are to be deposited into the Lee College volleyball fundraising account.

Camp Directed byROY CHAMPAGNEHead Coach at Lee College for 24 years

Career Highlights § For the � rst time in school history, led 2012-2013

Runnin` Rebels to Region XIV Champions and "Sweet 16" appearance at NJCAA national Tournament

§ AAU coach for over 10 years § Led his AAU team to a National Championship in 1991 § Coached 10 players who have gone on

to play professional basketball