Cincinnati Trailblazers Girls Summer Basketball Clinic 2015 The Cincinnati Trailblazer coaches invite you to spend the summer improving your basketball skills in a fun and encouraging environment. The first four weeks will be focused on footwork, ball handling, and shooting. The last four weeks will be 30-45 minutes of skills and the rest of the time playing – 3 v 3, 4 v 4, and 5 v 5. Optional workouts will be given each week for those who want to challenge themselves. Where: Springdale Nazarene Church, 11177 Springfield Pike, Cincinnati, OH 45246 Cost: $65 – Tee shirts included Who: Girls ages 10 – 18 Schedule: Tuesdays June 9, 16, 23, 30 - 4:00 p.m. to 6:00 p.m. July 14, 21, 28 – 4:00 p.m. to 6:00 p.m. August 4 – 4:00 p.m. to 6:00 p.m. Other: Each girl will need to bring a basketball (intermediate size, 28.5”) and water each week. Email Suzanne Riley ([email protected]) with your daughter’s intent to attend including name and age. Bring completed forms to the first day of the clinic along with check made payable to “Trailblazer Booster Club” Student’s Name:__________________________________________Age______ DOB________ Tee Shirt Size (circle one) YS YM YL S M L XL Student’s Name:__________________________________________Age______ DOB________ Tee Shirt Size (circle one) YS YM YL S M L XL Cincinnati Trailblazers Girls Summer Clinic 2015 Father’s Name:_____________________________________ Cell #__________________ Mother’s Name: ____________________________________ Cell # __________________ Address: __________________________________________________________________ Home Phone:__________________________Email___________________________________________ EMERGENCY INFORMATION Student’s Name:_________________________________________ Physician’s Name: ___________________________________________________ Physician’s Phone: ___________________________________________________ Notify In Case of Emergency: __________________________________________ Phone: __________________________________________ Do you carry insurance for your child(ren)? If yes, who is the insurance provider? _________________________________________________________________ Is your child(ren) currently taking any medications: _________ If yes, then please list medication and reason: ___________________________________________________________________________ If you are planning on leaving while your child is attending the clinic, please leave a number where you can be reached. ____________________________________________________________ PARTICIPATION WAIVER Due to the physical demands of this sports program, I, ___________________________, the parent of _____________________________________________________understand that there is a risk of personal injury to my child by participating in this program and accept complete responsibility for my child’s health and well being in this program. I also understand that no responsibility is assumed by the coaches or staff or facility where being held and will not hold them liable in the event of a personal injury. _______________________________________________ Signed ___________________________ Date