MAKE CHECKS PAYABLE:GENO FORD BASKETBALL CAMP, INC

QUESTIONS:genofordbasketball@gmail.com

MAIL TO:GENO FORD BASKETBALL CAMP, INC.P.O. BOX 198PORT JEFFERSON STATION, N.Y. 11776

DISCIPLINE:All campers are expected to conform to the stan-dards of behavior established by the Camp Director. Disruptive behavior could result in dismissal.

geno ford BASKETBALL elite campSUNDAY, AUGUST 4, 2019

12:00pm - 4:00pm ELITE CAMP REGISTRATIION - $90 PER PLAYER

LIMITED SPACE AVAILABLE - - Discount and refund Policy Available Upon request (OPEN TO ANY AND ALL BOYS ENTERING GRADES 8-12 IN THE FALL OF 2019)

Coach Ford brings great experience and a winning pedigree to the Stony Brook basketball program. He helped Kent State to the 2008 NCAA Tournament as an assis-tant coach before guiding the Flashes to back-to-back MAC regular season titles as a head coach in 2009-10 and 2010-11. Ford has helped lead Stony Brook’s offense to new heights since joining the staff in 2016, leading the Seawolves’ second highest scoring output in the D1 era in the 2018-19 season.

STONY BROOK HEAD COACH GENO FORD

TRAINERSWe have a certified medical trainer that

will be available all day at camp. Our

trainer will be available during check-in

to answer any questions you may have

about your camper’s medical care.

For campers who need to bring med-

ication with them, they must have a

bag labeled clearly with the campers

name and given to the certified

athletic trainer on duty.

MEDICAL FORM Each participant will be required to fill out an assumption of risk and medical form prior to the start of camp. This form must be completed in full for participants to take part in camp. Please print legibly on your camp application.

FACILITIESIsland Federal Arena is a brand new state of the art facility. It currently serves as the home to Stony Brook University Men’s and Women’s Basketball.

DIRECTIONSIsland Federal Arena (Indoor Sports Complex) Take Route 97 North to the North en-trance onto campus. At the top of the hill, make a right (Circle Road). Make your first left (Gym Road). The Indoor Sports Complex is the White/Grey building at the end of Gym Road.

2 TIME MAC COACH OF THE YEAR

- Won award twice in three years at Kent State University

BACK-TO-BACK MAC REGULAR SEASON TITLES

- First coach to achieve mark in 48 years

2008 NCAA TOURNAMENT BID

- Earned a 9-seed in Midwest Region as assistant

TWO D1 HEAD COACHES FROM HIS STAFF

- Rob Senderoff (Kent State), Patick Beilein (Niagara)

CHECK IN / CHECK OUT Check in takes place from 11:00am - 12:00pm through the large garage door off of main parking lot entering IFCU Arena.

CAMP STAFF Your instruction and development will come from members of the Stony Brook Basketball team and staff.

CAMP FEATURES• Skill Development

• Games and Evaluation

• Facility and Campus Tour

Player's Name___________________________________________

Age_________________Grade (Entering)____________________

Parent Email____________________________________________

Address________________________________________________

City______________________State__________Zip____________

Cell Phone _____________________________________________

Parent's Phone__________________________________________

T-Shirt (Adult Sizes) ______S ______M ______L ______XL ______XXL

2019 Geno Ford Basketball Camp, Inc.

Medical History Form

MEDICAL HISTORY FORM

Name of Camp Attending:_________________________ Number of Weeks Attending: 1 2 3 4 5 6 7 8 Personal Information Name of Camper: ___________________________ Sex: M F Birthdate: _________ Age:________ Name of Parent: _____________________________ Cell Phone: (____)___-______________________ Address: ___________________________________ Work Phone: (____)____-_____________________ ___________________________________ Home Phone: (____)___-______________________ Name of person to contact in an emergency:____________________________________________________ Relation to camper ________________ Cell Phone: (____)_____-_________________________________ Medical History Is child in good health: Yes or No If not, please explain: __________________________________________ ______________________________________________________________________________________ Should nature and amount of physical exercise be limited: Yes No If so, please explain:________________ _______________________________________________________________________________________ Does child have any allergies: Yes No If so, please explain:______________________________________ _______________________________________________________________________________________ Is child taking any medications regularly: Yes No If so, please explain:_____________________________ _______________________________________________________________________________________ Is child prescribed an inhaler or epi-pen? Yes No If so, please explain:_____________________________ _______________________________________________________________________________________ Assumption of Risk Statement I have registered my child, _____________________________, for the Geno Ford Basketball Camp, Inc., I am fully aware of the actual and potential risks of personal injury (including serious injury and death) inherent in this activity. By signing below, I am asserting that I knowingly and voluntarily assuming all such risks for my child as well as medical expenses incurred as a result of injury or illness to my child. Parent/Guardian Signature: _____________________________________ Date: ________________ Authorization for Medical Care I hereby authorize the Camp Director and/or Athletic Trainer from the respective Geno Ford Basketball Camp, Inc. to be responsible for my son/daughter, _________________________, for the purpose of medical attention. I also grant permission for an emergency physician to examine and treat, hospitalize or secure treatment for my child in the event of an emergency. Parent/Guardian Signature: _____________________________________ Date: ________________ Permission to Apply Topical Creams / Ointments I, ____________________________________, give permission for the caregivers/staff of the Geno Ford Basketball Camp, Inc. my child is attending to apply sunscreen/ointments to my child, __________________________________ while he/she is in attendance at the camp. Please do not apply _________________________________________ because of known or suspected allergic reactions. Parent/Guardian Signature: ______________________________________ Date:________________

3/2019