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Women's Basketball Camp Registration

Complete Registration Form in PDF Format
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Jan. 21, 2004

2004 LoyolaWomen's Basketball Camps

Please check which campyou are attending:

JUNE 21-24 OVERNIGHT CAMP (Ages 7-17)
Overnight $325______

Commuter $240______

JUNE 25-26GUARD/POST CLINIC CANCELLED

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

$200 ______

PLEASE PRINT CLEARLY

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.

Insurance Company:

____________________________________________

Policy #:

______________________________________________

PARENT/GUARDIAN PLEASE READ AND SIGN

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 .

__________________________________

Parent/Guardian Signature Date

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?

____________________________________________________________

ROOMMATE REQUEST:______________________________________

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

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