News

Camp Registration Form

Jan. 20, 2004

Please check which campyou are attending:

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??????????? JUNE 21-24?????????? OVERNIGHT CAMP?????????? (Ages 7-17) ????????????

???????????????????????????????????????????????Overnight??????????????????????????????????????????????? $325???????????????????????______

???????????????????????????????????????????????Commuter?????????????????????????????????????????????? $240???????????????????????______

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??????????????? JUNE 25-26???????????GUARD/POST CLINIC ????? (Ages 12-17)

??????????????????????????????????????????????????????????????????????????????????????????????????????????????$100??????????????????????? ______

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??????????????? JULY 26-29??????????? DAY CAMP ????????????????????????? (Ages 7-17)

?????????????????????????????????????????????????????????????????????????????????????????????????????????????? $200??????????????????????? ______

PLEASE PRINT CLEARLY????????????????????????????????????????????????????????????

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Medical Release: All campers must have their own medical coverage. Campers will not be allowed to play unless the following information is submitted and the form signed by a parent or guardian of the camper.

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Insurance Company:

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Policy #:

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PARENT/GUARDIAN PLEASE READ AND SIGN

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The undersigned, being a parent or legal guardian of the child requesting camp admittance, am familiar with the risks inherent in participation in the Loyola College Basketball Camp.? I hereby release Loyola College and the Loyola College Women's Basketball Camp Staff, its successors, assignees, officers, agents and employees from any and all claims, demands, and causes of action whatsoever in any way growing out or resulting from participation in the camp.? I hereby authorize the director of the Loyola College Basketball Camp to act for me according to their best judgment in an emergency requiring medical attention .

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Parent/Guardian Signature??????????????? Date

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Please make all checks payableto Loyola Women's Basketball Camp. A non-refundable $25 deposit isrequired with each application

NAME_______________________________________________________

PARENT'SNAME______________________________________________????????????????????????

ADDRESS____________________________________________________

CITY/STATE/ZIP______________________________________________

PHONE (H)________________________(W) _______________________

Emergency Contact Name/Phone__________________________________

EMAIL______________________________________________________

AGE______ HT______Position________ GRADE ENTER 8/04 ________

If started classes in the 9thgrade, have you earned a varsity letter?? Y?? or?? ?N

CAMPER'S SCHOOL__________________________________________

T-SHIRT SIZE (ADULT SIZES)

? ??____? ?Small? ____???Medium?? ?____ Large ? ____? X-Large

How did you find out aboutthe Loyola Basketball Camp?

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ROOMMATE REQUEST:______________________________________

?????????????????? ("Double" occupancy only, notriples. Please request each other.)

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Send application: Fax 410-617-2008 email amosley@loyola.edu or mail to

??????????????????????? Loyola College WBB Camp 4501 North Charles StreetBaltimore, MD 21210

For any questions please contact: Alisha Mosley - 410-617-5406