Lee College Community Education 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 Community Education Office in person, by mail, or fax.

Student Information (please print all information)

____________________________________________________ ____________________________________________________ ____________Last Name First Name M. I.

____________________________________________________ __________________________________ ________________ ____________Address City State Zip

____________________________________________________ _________________________ _________________________ o MalePrimary Phone Birthdate Entering Grade o Female

__________________________________________________________ _____________________________________________________________SSN# E-mail Address

Does this child have any disabilities, present injuries, allergies, hemophilia, heart conditions, history of respiratory illness, or any other significantmedical condition? oYes o No If yes, please state: ____________________________________________________________________________

Parent/Guardian Information

__________________________________________________________ _____________________________________________________________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 staff.)

__________________________________________________________ _____________________________________________________________Doctor’s Name Phone

____________________________________________________________________________________________ _________________________Parent or Guardian’s Signature Date

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

Non-Release of Directory Information: I o do o 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, activitiesparticipated in, dates of attendance, and degrees and awards received.

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

FOR OFFICE USE ONLY

______________________ _____________________ _______________________ _____________________ o RD o FERPAStudent ID # Receipt # Date Initials

Athletics

PO Box 818, Baytow

n, Texas 77522-0818

U.S. Postage

PAID

Baytown, Texas

Non-Profit O

rg.Perm

it No. 95

2015 BasketballSummer CampsGrades K - 12 (Coed)

www.lee.edu/athletics

Basketball Camps

Shooting Camp June 29 - July 1Coed 7th - 12th grades M 2:00 pm - 5:00 pm

Tu-W 9:00 am - 4:00 pm

Girls K - 4th grades July 6 - 10M-Th 8:00 am - 1:00 pmF 8:00 am - 12:00 pm

Girls 5th - 10th grades July 13 - 17M-Th 8:00 am - 1:00 pmF 8:00 am - 12:00 pm

Boys K - 4th grades July 20 - 24M-Th 8:00 am - 1:00 pmF 8:00 am - 12:00 pm

Boys 5th - 10th grades July 27 - 31M-Th 8:00 am - 1:00 pmF 8:00 am - 12:00 pm

Typical Camp Day8:00 - 8:15 Warm up, stretching, and easy

running8:15 - 8:30 Pistol Pete ball-handling routine8:30 - 9:40 Station work9:40 - 10:00 Break time

10:10 - 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 - 1:00 3-on-3 games

Camp Features• Air-conditioned arena• Camp t-shirt• Motivational booklet• Daily refreshments• Special guest speakers• Enthusiasm• Family atmosphere• Certified licensed trainer• Camp basketball• Camp certificate

Camp Registration Starts May 1, 2015Due to the overwhelming response from last year’scamp, only a limited number of applications persession will be accepted. Each session will be on afirst-come, first-served basis

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

Discounts for children in the same family. First childpays $95. Each additional family member (brotheror sister) pays $50.

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

EquipmentCampers should report each day wearing basketballshoes, athletic socks, shorts, and camp t-shirt. Nocaps, watches, or jewelry will be permitted, PLEASE!

Camp AwardsAn awards ceremonywill conclude each weekof camp. The ceremonywill be conducted at11:50 each week withawards for each agegroup for the followingcategories:

• Mikan layups• Hot shot shooting• Freethrow shooting• 3-on-3 competition

In addition, every camper will receive a certificate ofmerit for participation in the camp.

Camp Goals• Each camper will leave with a positive attitude.• Each camper will leave the camp closer to reach-

ing their full potential on the basketball court.• Each camper will learn the proper fundamentals

and develop the confidence in their abilities sothey can utilize the skills they learned in thecamp.

• Each camper will learn how to appreciate andlove the game of basketball.

• Each camper will be exposed on how to conductthemselves on and off the court through sports-manship, competition, and learning how to dealwith winning and losing.

• Each camper will learn that to be successful theywill need to find 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 dayafter camp concludes. Runnin’ Rebel merchandiseand other items will be available for purchase. LeeCollege will provide a camp bank so campers canstore their money without the fear of losing or misplacing it.

Ways to RegisterIn person: 909 Decker Drive, Baytown, TX

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

By Mail: Lee College Community EducationP.O. Box 818Baytown, TX 77522-0818

For more information call 281.425.6311

Circle Payment:

Cash Check Visa MC Discover 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 basketball fundraising account and will helpto fund future needs for the Runnin’ Rebels program.

Camp Directed byRoy Champagne• Head Coach at Lee College

for 22 years• For the first time in school

history, led 2012-2013 Runnin` Rebels to RegionXIV Champions and "Sweet 16" appearanceat NJCAA national Tournament

• AAU coach for over 10 years• Led his AAU team to a National Champi-

onship in 1991• Coached 10 players who have gone on to

play professional basketball

Shooting CampCoed 7th - 12th grades

• Individual breakdown of shot• Footwork/shot preparation• How to get open to score• Freethrow shooting• Live/deadball drills• Learn how to study your shot• Film breakdown of each camper’s

mechanics

Shooting Camp Dates:Monday, June 29 2:00 pm - 5:00 pmTuesday, June 30 9:00 am - 4:00 pmWednesday, July 1 9:00 am - 4:00 pm

Food will not be provided for campers.Make sure to either bring lunch or money.