2018 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 2018-2019 school year *
SELECT THE GRADE YOUR SON WILL BE IN FOR NEXT SCHOOL YEAR
School (Fall 2018) *
Enter the name of the school that your son will attend next year
Your answer
Email address *
Your answer
Street address *
Your answer
City *
Your answer
Zip Code *
Your answer
Parent/Guardian Last Name *
Your answer
Parent/Guardian First Name *
Your answer
Emergency Phone Number *
Your answer
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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