2017 Lady Raven Basketball Youth Basketball Camp Enrollment
Please completely fill out the following and submit.
Your enrollment will not be complete until we receive your camp fee of $75 (or deposit of $35) made out to JOEL BRANSTROM. A Confirmation email will be sent to the email address you provide once payment has been received.
Camper's LAST Name
Camper's FIRST Name
Which Session Do You Wish to Attend?
Session 1: 9-11AM Beginner/ Intermediate (Recommended for Grades entering 1st-5th +) or Session 2: 12-2PM Intermediate/ Advanced (Recommended for Advanced 5th Graders & those entering 6th-8th)
Session 1 @ 9-11AM
Session 2 @ Noon-2:00PM
Grade Entering Fall of 2017
What School Will they Attend in the Fall of 2017?
Parent/ Guardian Names
Please Confirm Above Email:
Preferred Emergency Phone Number
* with Contact Name (& relationship) * Ex. (913) 987-6543 John (dad)
Secondary Emergency Phone Number
*with Contact name (& relationship)
Any Medical Issues we need to be aware of?
* If "yes" click on "Other" and please describe the condition along with what we need to know.
Camper T-Shirt Size:
I hereby agree to accept full and complete responsibility for all medical or other expenses necessary as a result of injury during the Olathe Northwest Lady Raven Basketball Camp. I also agree to release Olathe Public Schools and all camp staff from liability for injuries or accidents that might occur due to participation in camp activities, or that result in transit to or from Olathe Northwest Basketball Camp. I understand that this camp is not a school sponsored event.
Disagree ...If "Disagree" we will need documented rationale of your refusal to agree along with your signature
Registration/ Payment Confirmation
I understand my registration will not be complete until Coach Branstrom receives payment via the mail and then I will be given a confirmation email that my child's registration has been accepted.
No, please contact me with more information
Please Make your Check or Money Order to : JOEL BRANSTROM
Please send Check/ money order of $75 (or $35 nonrefundable deposit) to: 22453 W. 113th Terr., Olathe, KS, 66061
A copy of your responses will be emailed to the address you provided.
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