Print this page and return completed form with fee to the address below
name
 
address
 
city
 
state
 
zip
 
home phone
 
grade (fall 2017)
 
school
 
t-shirt size
email:
 
emergency medical information
work or cell phone
 
medical conditions we should be aware of...
 
 
in case of emergency, call (other than parent/guardian)
 
parent's release and indemnity agreement to
basketball campman basketball camps

In consideration of the acceptance of this application for enrollment in any of the Basketball Campman Basketball Camps, I/we, intending to be legally bound, hereby for myself, my heirs, executors and administrators, waive and release any and all rights and claims for damages I may have against Basketball Campman Basketball Camps, all sponsors and all employees and agents of Basketball Campman Basketball Camps for any or all damages which may be sustained and suffered by me in connection with my/our association with, or entry into this camp, and which may arise out of my traveling to, participating in or returning from the camp. I/We hereby grant permission for my/our child to be a participant in the specified Basketball Campman Basketball Camp and if an injury should occur during, traveling to or returning from the camp, I/we agree to pay for all costs, present and future, through my/our medical insurance policy and/or personal finances.
parent/guardian signature
 
date
 


 Please check you choices below.

 CLINICS


 MICHAEL BORN CAMPS
  Competition Camp
    - Des Moines, IA
  Nothin' But Net Cam
    - Des Moines, IA
  Holiday Hoops Camp
    - Des Moines, IA

 Be sure to include a check for the
 amount stated on the respective
 camp page.