2008 Application Form
East Coast Basketball Camp
(Please Print)
Name___________________________ T-shirt size_______________________
Address_________________________________________________________
City, State, Zip____________________________________________________
E-mail__________________________________________________________
Phone______________________ Emergency number_____________________
Session(s): June 16-20______; June 23-27________; Both___________
Age as of 1st day of camp________Height______Male/Female______________
Grade in 2008-2009 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
240 Valencia Circle
Winston-Salem, NC 27106