2012 Lady Raven Basketball Camp -HS

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Please completely fill out the following and submit.

Your enrollment will not be complete until we recieve your camp fee of $75 (or deposit of $35). A Confirmation email will be sent to the email address you provide once payment has been received.

A Camp T-Shirt and Practice Shorts will only be guarenteed to those campers who pre-register and have their fee in by Friday, June 8th.

Last Name *

First Name *

Grade *

*Entering fall of 2012

School attended during 11-12 school year? *

ONWHS

PRT

SFT

Other:

Parent/ Guardian Name(s) *

Parent Email Address *

Perferred Parent/ Guardian Phone Number *

Emergency Contact (Name & Phone Number) *

Any Medical conditions we should know about? *

Yes (please explain in "other")

Other:

Shirt Size *

Adult sizes

Small

Medium

Large

Practice Short Size *

Unisex Sizes

Small

Medium

Large

XXL

Consent *

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.

Yes

If "No" 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.

Yes

Please

make checks/ money order out to: "JOEL BRANSTROM" Your enrollment will not be complete until we receive your camp fee of $75 (or deposit of $35). A Confirmation email will be sent to the email address you provide once payment has been received. Send checks to: 22453 W. 113th Terr, Olathe, KS, 66061

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