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Camp Registration


Welcome to the annual Norris Cole Basketball Camp!  The Norris Cole Basketball Camp will be providing campers with fundamental skill development, character development, team play and more. Campers will have daily interaction with Norris.  Lunch will be provided to the campers daily. Parents will need to provide lunch for campers with allergies and/or special dietary needs/restrictions.

The Camp will be conducted July 30 – August 2, 2018, 9 A.M to 3 P.M. for boys and girls ages 6-15.

Camp Highlights include:

·      Autograph session with Norris

·      On court action and game play

·      Guest speakers

·      Special prizes

Every camper can count on an exciting week of skill development, competition and fun.  All registered campers will receive a camp T-shirt.

The cost of the camp is $150.00 and open to the public for ages 6-15 as noted above.  Participants are encouraged to register prior to the day of the event.  Onsite registration will be available but space is limited.

In consideration of participation in the Norris Cole Basketball camp as described herein, and having actual knowledge and appreciation of the particulars of the program and those risks involved in this type of activity/programs, I on behalf of my child, voluntarily consent to use the facilities and participation in the activities/programs at this site, and assume all the risks arising therefrom.  Each camper must be covered by his/her parent's insurance before participating in any of the camp activities.  I hereby declare that my child is in good health and has no mental or physical condition or symptoms that could interfere with her/his safety or the safety of others while participating in any activity using any equipment or facilities of the Ray & Joan KROC Corps Community Center.  Furthermore, I certify that (s)he has adequate health insurance to cover any injury or damage that (s)he may suffer while participating, or alternatively agree to bear all costs associated with any such injury or damages to her/him.

I, the undersigned, do hereby release, hold harmless, indemnify, waive and discharge the Norris Cole Basketball Camp, Ray & Joan KROC Corps Community Center, and all its officers, agents, employees from and against any and all claims, demands, actions or causes of actions arising from any injuries or damages my child may suffer or sustain from her/his participation in, or use of, any facility, equipment, and/or programs.  Furthermore, in full recognition and appreciation  of the potential dangers and hazard inherent in athletic and other activities, I do hereby agree to assume any and all risks, liabilities, and responsibilities for all accidents, injuries, damages, or property losses arising from my child's participation.

I the event of a medical emergency requiring more than basic first aid, I authorize the Norris Cole Basketball Camp to secure from any licensed hospital, physician and/or medical personnel any treatment deemed necessary for my child's immediate care and agree that I will be responsible for payment of any and all medical services rendered.

Photo Release:  The Norris Cole Basketball Camp may occasionally take pictures of our camp participants for use in its promotions/advertisements materials or publications (brochures/websites, ads, etc).  By signing this consent, I agree to allow the Norris Cole Basketball Camp and staff to reproduce the likeness of my child in such promotional/advertisement materials or publications.

For additional information call:  937-479-6694

To register, compete the form and pay below.

Participant *
Phone *
Please provide any and all allergies to foods and/or medications; and physical restrictions.
Medical Conditions
Please check all that apply
Last Tetanus Immunization
Last Tetanus Immunization
Name of Emergency Contact 1 *
Name of Emergency Contact 1
Cell Phone *
Cell Phone
Name of Emergency Contact 2 *
Name of Emergency Contact 2
Cell Phone *
Cell Phone
Parent/Guardian E-Signature
Parent/Guardian E-Signature
Camp Registration Fee
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