2022 Summer Basketball Camp Registration Form
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First Name of Camper *
Last Name of Camper *
Date of Birth *
Age *
Grade (Entering in fall 2022) *
Gender *
T-shirt Size *
***Register by June 1st to receive a LYA Hoop Camp t-shirt. T-shirts may not be available for late registrants***
Parent(s)/Guardian(s) Name(s) *
Mailing Address *
City *
State *
Zip Code *
Phone Number *
Email *
Please check the weeks your child will attend camp. *
Week #1 = $70, Week #2 = $70, Week #3 = $55, Week #2 and #3 = $115, Single days = $20 / day
Single Days (List dates):
(Space may not be available for partial weeks. Preference will be given to those who sign up for complete weeks.)
Please list any medical conditions we should be aware of including asthma and allergies:
Payment, documentation of physical, and any other items can be mailed to:
Lee Middle and High School
Attn: Dan Korte
300 Greylock Street
Lee, MA 01238

Deposit NOT required with online registration - Balance due 1st day of camp - Checks made out to: “LYA”

Documentation of a physical exam completed within the past 13 months is required by the first day of camp.
Waiver (Required)
I, the parent/guardian of the above named camper, understand and accept the condition that no one associated with the camp will assume any responsibility for accidents and medical expenses as a result of participating in the camp. The applicant is in good health and is able to participate in the physical activity of the rigorous program. I hereby authorize the director of the camp to act in an emergency requiring medical attention for my son/daughter.
Electronic Signature *
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