Day Camp Session 1 – 3x – chrisklimchockbballcamp.com

$600

$570

When – June 15th-18th

Time – 9:00am-3:00pm, * There will be early drop-off available at 8:00am and late pick-up at 4:00pm

Where – Chambers Hall Gymnasium located on the campus of the University of Pitt Greensburg

Cost – $570 (All campers will receive a T-Shirt and a basketball)

Please fill out the form below:
Fields marked with an asterisk * are required

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(3x) Day Camp Session 1 Registration

Camper #1 Name

Camper #1 Age

Camper #1 T-Shirt Size

Camper #1 Address

Camper #1 City

Camper #1 State

Camper #1 Zipcode

Camper #1 Parent/Guardian Name

Camper #1 Parent/Guardian Email

Camper #1 Parent/Guardian Phone

Camper #1 School

Camper #1 2026 Fall School Grade

Camper #1 Date of Birth

Camper #2 Name

Camper #2 Age

Camper #2 T-Shirt Size

Camper #2 Address

Camper #2 City

Camper #2 State

Camper #2 Zipcode

Camper #2 Parent/Guardian Name

Camper #2 Parent/Guardian Email

Camper #2 Parent/Guardian Phone

Camper #2 School

Camper #2 2026 Fall School Grade

Camper #2 Date of Birth

Camper #3 Name

Camper #3 Age

Camper #3 T-Shirt Size

Camper #3 Address

Camper #3 City

Camper #3 State

Camper #3 Zipcode

Camper #3 Parent/Guardian Name

Camper #3 Parent/Guardian Email

Camper #3 Parent/Guardian Phone

Camper #3 School

Camper #3 2026 Fall School Grade

Camper #3 Date of Birth

Parent Medical Consent:

As the parent or legal guardian of the above-named child, I hereby give my full consent and approval for my child to participate in Chris Klimchock Basketball Camp. I understand there are risks of injury in any sport and am willing to assume these risks on behalf of my child.

I hereby certify that my child is fully capable of participating in this camp and that my child is healthy and has no physical or mental disabilities or infirmities that would restrict full participation in this activity.

I accept all financial and medical responsibilities for my child, and authorize coaches/supervisors to obtain emergency medical care if necessary during camp.

In giving my full consent for my child’s participation, I do hereby waive, release and hold harmless the Chris Klimchock Basketball Camp and its coaches/supervisors for any injury that may be sustained by my child in the normal course of participation in this camp and the
activities incidental thereto, whether the result of negligence or any other cause.

I acknowledge and agree that any photos/images taken during camp may be used in future promotional media for the camp.

Consent

Yes

Sign your name if you agree

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