Insurance and Health Information
Insurance Co. Name & Policy Number
______
______
Guardian/Parents Name ______
Home Phone ______
Work Phone ______
Additional Emergency Contact ______
Phone ______
Authorization to Consent to Health Care for a Minor
The undersigned, being the custodial parent or guardian having legal custody of the said minor child, authorizes the staff of Heather Macy’s, Focused 50 Basketball Camp: (1) to provide for such health care at any hospital or other institution, or the employing of any physician, dentist, nurse, or other persons whose services may be needed for such health care, and (2) to consent to and authorize any health care, including administration of anesthesia, X-ray examination, performance of operations, and other procedures by physicians, dentists, and other medical personnel, except the withholding or withdrawal of life sustaining procedures. By signing here, I agree to pay through my health insurance coverage or otherwise for any medical treatment provided under this authorization. I also agree to release and discharge Heather Macy’s Focused 50 Basketball Camp and its staff from any and all claims, demands, liabilities, obligations, actions or causes of action known or unknown for any injuries incurred by said minor child while attending Heather Macy’s Focused 50 Basketball Camp or treatment for such injuries.
Signature of Parent/Guardian is required
X______
THE FOCUSED 50 PHILOSOPHY
…Instruction is #1.
This camp was designed especially for players who strive to become better. We stress development - player development and people development. Our hope is that each camper leaves the Focused 50 with a better understanding of the game & realizes the level of work ethic that it takes to compete at a high level. We believe in limiting the camp to a small number of campers. This enables the staff to talk with players about college, out-of-season practices, and other relevant topics. Classroom instruction, video sessions, & round table discussions all make the Focused 50 a unique experience for each camper. We will not promise to turn campers into franchise players overnight, but we will give them the tools and concepts to work toward being the best they can be!
WHAT’S BEING SAID ABOUT
THE FOCUSED 50?
“…One of the most intense and informative camps with which I’ve ever been involved.”
Karen Barefoot, Head Coach
“The one-on-one instruction from both college coaches and players was the best.”
Danielle Duffy, Former Camper
“The Focused 50 camp believes in the greater development of student-athletes, not just their athletic potential. Both academic achievement and sportsmanship are addressed at the camp.”
Dr. Woody Gibson, Director of Athletics
“You push yourself to limits you never thought you could reach. If you want to have fun and learn more about basketball this is the camp.”
Monique Dawson, Former Camper
Coach Heather Macy
The Focused 50 Basketball Camp
5828 Weaver Road
Hamptonville, NC 27020
www.geocities.com/focused50/home.html
336-420-2722
Elite Position One Day Camp
Saturday, June 4
Alex Spears YMCA, Greensboro, NC
Friday, June 10
Fayetteville Academy, NC
Saturday, June 11
Heritage High School
Newport News, VA
«NEW TO THE FOCUSED 50«
Hot Shot Shooting Academy
Sunday, June 12
Heritage High School, VA
Back & Expanded
by Popular Demand
ELITE POSITION ONE DAY CAMP
Locations: Greensboro, Fayetteville, & Newport News
The Focused 50 Position Camp is ideal for players to refine their skills at their specific positions. The Position Camp will cover topics directly related to each player’s position and needs. The Focused 50 Position Camp is for the player that desires to know the ins and outs of her position.
POSITION CAMP HIGHLIGHTS
▪ Position specific competitions
▪ State of the art facilities and multiple
basketball courts
▪ Round table discussions with coaches
and players regarding your specific position
▪ Emphasis on individual skill development
Defining…
DISCIPLINE, COMMITMENT
& INTENSITY
«NEW TO THE FOCUSED 50«
HOT SHOT SHOOTING ACADEMY
Locations Include: Greensboro, NC (mini-clinic) &
Heritage High School, Newport News, VA
If you want to learn techniques and drills to develop the perfect shot, then mark June12th on your calendar. Highlights of this camp include videotaping and reviewing of each players shot and learning the proper mental approach to shooting. The staff includes college coaches from every level, college players, and players with professional playing experience. As always, The Focused 50 prides itself on top level coaches and instructors.
REGISTER TODAY
TO EXPERIENCE THE FOCUSED 50!
Remember to take advantage of the
Early Bird & BONUS specials.
WHAT TO EXPECT IN 2005
▪ 8:1 Camper/Coach Ratio
▪ Enthusiastic and qualified coaches
▪ Exposure to offensive skills and
instruction in small groups
▪ An action-packed day of basketball
▪ Meeting campers who have goals &
aspirations to be the best basketball
players they can be
▪ Offensive and defensive techniques and
fundamentals currently utilized at the
high school and college levels
▪College recruiting information session
that answers eligibility and preparing for
college questions
▪Campers will learn how much FUN
playing basketball can be when they
learn the fundamentals properly
Focused 50 Basketball Camp Application
(Please Circle Camp(s))
$90.00 Elite Position One Day Camp (Saturday, June 4)
ALEX SPEARS YMCA (Greensboro, N.C.)
Registration begins at 8 am/Dismissal 8 pm
Financial Investment Includes Hot Shot Shooting Mini Clinic
$75.00 *Early Bird Special (Before April 1, 2005)
$75.00 Elite Position One Day Camp (Friday, June 10)
Fayetteville Academy (Fayetteville, N.C.)
Registration begins at 8:30 am/Dismissal 5 pm
$75.00 Elite Position One Day Camp (Saturday, June 11)
Heritage High School (Newport News, VA)
Registration begins at 8:30 am/Dismissal 5 pm
BONUS Special: Elite Position Camp (June 11)
$100.00 AND
Hot Shot Shooting Academy (June 12)
$40.00 Hot Shot Shooting Academy (Sunday, June 12)
Heritage High School (Newport News, VA)
Registration begins at Noon/Dismissal 5 pm
$______Total Amount Enclosed
Name:______
Address:______
City: ______State: ____ Zip:______
E-mail: ______
Phone number: ______
Graduation Year: ______
School: ______
Circle Position: Point Guard Guard Post
Please mail the enclosed application and
non-refundable payment to:
Heather Macy, Focused 50 Basketball Camp
5828 Weaver Road Hamptonville, NC 27020
Medical Release & insurance information located on reverse
Make Checks Payable to: Heather Macy, Focused 50