Southeastern Jr. Elite Hoops Camp
Email *
Campers Name: First , Last
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Home Address (Example 2324 Cumming Rd City, State, & Zip Code
Parent/Guardian Name
Parent/Guardian Cell
Parent/Guardian Email Address
School Next Year
Grade for the 2021-2022 Academic
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School Coach Name
School Coach Cell
School Coach Email Address
Stats ( APG) per game
Stats (PPG) per game
Stats (RPG) per game
Team Record
List basketball awards
Jersey Size (Adult sizes)
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Shorts Size (Adult Sizes)
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Travel Basketball Team Name
Travel Basketball Coaches Name
Travel Basketball Coach Cell Number
Travel Basketball Coaches Email Address
Have you had a physical this school year?
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Do you have insurance?
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If yes, Insurance company name, policy #, and phone number
Are your allergic to any food or medication?
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If yes you are allergic, please list
Parents Waiver Consent
I hereby state that the Southeastern Jr. Elite Hoops Camp, employees, sponsors and staff is not responsible for any pre-existing injury or reoccurrence of any pre-existing injury or illness prior to the first day of camp and will assume responsibility only for injuries incurred while the above camper is participating in activities under supervision during the enrolled camp period. Furthermore, in accordance with the rules of basketball and training, I hereby give my consent for the camper to receive professional medical attention and whatever professional services and medical facility as deemed necessary by the staff.
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