BACK                                             

2010 Application Form
East Coast Basketball Camp

 

(Please Print)

Name___________________________ T-shirt size_______________________

Address_________________________________________________________

City, State, Zip____________________________________________________ 

E-mail__________________________________________________________

Phone______________________ Emergency number_____________________

Age as of 1st day of camp________Height______Male/Female______________

Grade in 2010-2011 school year____________School attending______________

I waive and release East Coast Basketball Camps from any and all liability from injury and illness going to camp from home or while at camp or while returning home. I, as parent/guardian, have actual knowledge and appreciation of the particulars of the program and hereby voluntarily consent to said minor's participation, and assume the risk arising therefrom. I hereby give my permission for emergency medical treatment in the event I can not be reached.

East Coast Camps requires a physical examination within the 12 month period of the date the camper is scheduled to attend camp. 

Signature of Parent/Guardian:________________________________________________________

Date:___________________________________________

Mail completed application along with your tuition to:

East Coast Basketball Camp
310 West 4th Street
Suite 405
Winston-Salem, NC  27101

 

                                                            BACK