Jan. 21, 2004
2004 LoyolaWomen's Basketball Camps
Please check which campyou are attending:
JUNE 21-24 OVERNIGHT CAMP
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.
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
Emergency Contact Name/Phone____________________________
GRADE ENTER 8/04 ________
If started classes in the 9thgrade, have you earned a varsity letter? Y or N
T-SHIRT SIZE (ADULT SIZES)
____ Small ____Medium ____ Large ____ X-Large
How did you find out aboutthe Loyola Basketball Camp?
("Double" occupancy only, notriples. Please request each other.)
Send application: Fax 410-617-2008 email firstname.lastname@example.org or mail to
Loyola College WBB Camp 4501 North Charles StreetBaltimore, MD 21210
For any questions please contact: Alisha Mosley - 410-617-5406