For beginner, intermediate, advance level players (co-ed)

-Ages 7-15

_____________________________________________________________________

-Camps offer campers a structured basketball learning experience that encourages team participation and person development.

-Camps focuses on improving camper's skill while emphasizing game fundamentals from some of the best coaches in the game

-Campers will gain fundamental knowledge of the game

______________________________________________________________________

CAMP SCHEDULE (SUBJECT TO CHANGE)

9:00am: Dynamic stretching

9:30am: Instructional stations

10:30am: Skill Competition

11:00am: Scrimmages/games

12:00pm: Lunch and rest

12:30pm: Free play/group shoot around

1:00pm: Team O & D Development

1:30pm: Scrimmages/games

3:00pm: End of camp

Player Playing Experience (SC) *

Are you interested in registering for our bundle package? *

Parent/Guardian Information

First Name *

Last Name *

Email *

Phone *

Parent/Guardian 2 First Name *

Parent/Guardian 2 Last Name *

Parent/Guardian 2 Email *

Parent/Guardian 2 Cell Phone *

Alternative Pick up Person First Name *

Alternative Pick up Person Last Name *

Alternative Pick up Person Phone Number *

Home Address

Address

Street Address *

State *

City *

Postal code *

Type your Unit or Apartment No. *

Player Information

How many children will register today? *

Is this child a sibling of current registrant? *

Child's First Name *

Child's Last Name *

School *

Gender *

#1 Child Date of Birth *

Grade *

#2 Child's First Name *

#2 Child's Last Name *

#2 Child's School *

#2 Child's Gender *

# 2 Child's Date of Birth *

#2 Child's Grade *

#3 Child's First Name *

#3 Child's Last Name *

#3 Child's Gender *

#3 Child's Grade

#3 Child's Date of Birth

#3 Child's School

Emergency Contact

Primary Emergency Contact First Name *

Primary Emergency Contact Last Name *

Primary Emergency Contact Relationship to Player *

Primary Emergency Contact Cell Phone *

Medical History

Does the player have any other medical conditions that we need to be aware of?

Medical Conditions 1 *

Medical Conditions 2

#2 Child's Medical Conditions 1

#2 Child's Medical Conditions 2

#3 Child's Medical Conditions 1

#3 Child's Medical Conditions 2

Camp Forms

CAMP FORMS

Please Upload Code of Conduct Here

Please Upload a signed Medical form here

Code of Conduct

Camp Philosophy and Behavioral Expectations

Every Camper has the right to a happy and safe experience at Breakaway PEP Camps. All Breakaway PEP camps focus on developing the basketball skills of every camper and addressing the collective needs of the group. Our goal is to help each camper develop new skills and a greater appreciation of his/her capabilities. We hope to provide a community setting in which campers will have the ability and confidence to gain new skill sets and meet new friends. Every experience is a learning experience, and it is the responsibility of the coaches to provide a well-rounded program for all children. We aspire to create a safe and stimulating environment for all campers where sensitivity, respect for others, and cooperation are valued.

The code of conduct is intended to be a guide for general behavior for the Breakaway PEP community and includes the following expectations:

1. Each person is respected and valued.

2. Each person has a responsibility to help make camp a better place

3. Each person is expected to choose appropriate behavior and language and encourage others to do so.

4. Each person is expected to think about the results to think about the results of one's actions and how they impact others.

5. Each person is expected to solve disagreements by talking, listening, and compromising.

Consequences for Inappropriate Behavior

If a counselor is unable to resolve a conflict through discussions, redirections, and reviewed expectations, staff will proceed with the following steps:

1. The Counselor gives an official warning, which includes a clear explanation of the concern and suggestions for alternative behaviors that should be used in the future. This may include a time-out.

2. The Camp Director talks with the camper about expectations and communicates with parent(s)/guardian, explaining the concern.

3. A conference with the camper, parent(s)/guardian, and Camp Director will be arranged to discuss a plan of action for resolution of the concern. This could include suspension from camp for a period of time. No refunds will be made for any time a camper is suspended due to inappropriate behavior.

If the situation is judged by the administration to be very serious, the above steps may be waived, and a parent/guardian may be asked to pick up the child from camp, and the camper may be asked not to return to camp for a designated period of time.

Please read and discuss this code of conduct form with your child. Sign this form to complete your registration.

Uniform

Get your official Breakaway Hoops jerseys

at our shop!

GO TO SHOP

Location Details

Must bring your own water bottles (6 minimum)
Brown Bag Lunch (No Peanut Based Food)
Must bring Breakaway Hoops Jersey & Shorts
Extra T-Shirt
Non-basketball glasses are not to be worn at any point on the basketball court.

Is this your first time registering for Summer camp or you are in need of additional weeks

Which weeks will you be attending? *

Week 1-AUGUST 17-21-FUNdamentals Camp

Week 2-AUGUST 24-28-SHOOTING CAMP

Is your child allowed to go home by him or herself? *

Referrer Information

Direct Summer Camp Referrer? *

Direct Summer Camp Referrer First Name *

Direct Summer Camp Referrer Last Name *

Direct Summer Camp Referrer Phone Number *

Payment Option

Pay In Full

I Consent to Receive SMS Notifications, Alerts & Occasional Marketing Communication from company. Message frequency varies. Message & data rates may apply. You can reply STOP to unsubscribe at any time.

I understand I have registered for full or subscription payments for Summer Camp payment plans.
I understand my card on file will be billed on an automatic recurring monthly basis (including holidays) depending on my payment option during check out.
I understand if it is my intention to withdraw from my registered class, I must do so by filling out a requested withdrawal form sent via text message.
If a withdrawal form is not completed at least 7 days or greater prior to my next billing date, I will be automatically billed and there are no refunds provided
I understand there are no refunds after May 1 under any circumstances.
After May 1 date, a credit towards a future camp or class may be applied.
I understand fully what I am signing up for and have read the terms and conditions.

Parent/Guardian Signature *

Clear