Basketball Skill Camp Step 1: Register Dates: June 20th -24th Monday through Friday 9 a.m.-12:00 p.m. There is no cost to participate.Age groups: Going into 1st grade through going into 6th gradeCamper’s LAST NameFIRST NameGenderMaleFemaleGrade ENTERING Fall 2022Date of BirthStreet AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeCountry AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemen Arab Rep.Yemen DemocraticZambiaZimbabwePhoneEmail Address(Confirmations of registration will be sent by email unless no family e-mail address is available)Father’s/Guardian #1 NameEmergency Phone #’sMother’s /Guardian #2 NameEmergency Phone #’sCamper lives with (if different than above):Relationship to camper?Camper’s Home Church: (Church Name/City)ALL CAMPERS SHOULD BE AWARE AND AGREE:RULES:1) I will at-all-times listen to and respect all authority figures of the NLBC basketball skills staff.2) I understand that if I cause a disruption and am asked to leave, that I forfeit my deposit/registration money and any awards.3) NLBC will not transport any campers home during the camp time. If I am asked to leave, my parent or guardian will be responsible to pick me up immediately.4) This is a skills camp, not a team tournament. There will not be team competitions or games played. All instruction is one-on-one to make each camper a better athlete.5) There will be services of Bible teaching as well as basketball skills. All campers will be expected to participate respectfully.“I, the camper, understand that the main purpose of this camp is to help me: 1) learn basketball skills, and 2) grow spiritually. The rules of the camp are based on the Christian value system. I, the camper, have read the rules above and agree to cooperate fully.”SignatureStart signing your signature hereYour browser does not support e-Signature field.Early Registration Deadline: May 20th to ensure camper receives a shirtEarly Registration Deadline: May 20th to ensure camper receives a shirt Indicate Shirt size of Camper:Youth S (6/8)Youth M (10/12)Youth L (14/16)Adult S Adult MAdult L __XL ___2XL (+$2.00) 3XL (+$2.00)Send Message Step 2: Health Form Camper’s Legal NameDate of BirthRequired - Year of Last Tetanus Booster(Sometimes referred to as DTP or Td or Tdap on health forms.)Check boxes for up to date Vaccinations as required for school entryDiptheria - Tetanus - Pertussis Series (DTP) Hepatitis B SeriesPolio SeriesVaricella (or had “chicken pox”)Measles - Mumps - Rubella (MMR)PLEASE NOTE if camper has any of the followingConvulsive DisordersChronic/Recurring IllnessFrequent Ear InfectionsADD/ADHDRecent Illness or InjuryContagious Disease(s)Overall Good Health to participate in camp activitiesRecent conditions that may restrict this camper from certain camp activitiesOptional: Any recent life changes (death in the family, divorce, etc.)Allergies: Please list any food, medication, insect, etc. allergies & describe reaction & management of reactionAllergyReaction/ManagementRx- Please list ALL medications your student will need while with us (Prescription/Over-the-counter/Herbs) must be in original container & turned in upon arrival.Name of MedicationDosageReason for takingPlease return Registration & payment to: New Life Baptist Church 10035 Poe Street Leesburg, Florida 34788Office Phone (352) 728-0004Email – pastor@NLBCLeesburg.orgWebsite – www.NLBCLeesburg.org“My child may be given over-the counter medication as deemed necessary by the camp staff, according to protocol, for comfort measures.”InitialsYour browser does not support e-Signature field.(Aspirin will NOT be given) ExceptionsWeight of camper (for dosage)Camper’s PhysicianPhysician PhoneHealth Insurance InformationInsurance CompanyPolicy/Group #Insured’s Date of Birth (not camper)Emergency Phone NumbersParent/Guardian NamePhone #’s w/ area codesIf Parent/Guardian is not available, please contactNamePhoneRelationship to camperIn the event of emergency, I give NLBC permission to care for and transport my child for any needed medical assistance. I hold N.L.B.C. harmless for any potential injuries that may occur.SIGNATURE MUST BE WITNESSED BY OUR STAFFStop by the office Tues-Fri 10am-5pm, or on the 1st day of campSignatureStart signing your signature hereYour browser does not support e-Signature field.Send Message