2017 Mark Villines Boys Summer Basketball Camp Registration
Last name
Your answer
First name
Your answer
Age
Your answer
Birth date
Example: 09/12/2003
Your answer
Grade entering for 2017-2018 school year
SELECT THE GRADE YOUR SON WILL BE IN FOR NEXT SCHOOL YEAR
School (Fall 2017)
Enter the name of the school that your son will attend next year
Your answer
Email address
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Street address
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City
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Zip Code
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Parent/Guardian Last Name
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Parent/Guardian First Name
Your answer
Emergency Phone Number
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Home/Cell Phone Number
Your answer
Family Doctor
Your answer
Doctor's Phone Number
Your answer
T-Shirt Size
Consent To Participate
By typing in my name and understanding that it is an electronic signature, I give permission for my child (name entered above) to participate in the Mark Villines summer program listed above. I hereby agree to waive all claims and hold harmless Mark Villines and all camp workers, the school district, its' officers and employees from all claims arising from their reliance on this consent form.
Your answer
By checking the yes box below, I am verifying that I understand the payment options
Make checks payable to: MARK VILLINES. Payment may be made on the first day of camp or mailed to: MARK VILLINES at 500 N. Industrial Blvd. Euless, TX 76039
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