Maconaquah Lady Braves Basketball Academy Camp Form: Fall 2019
Please fill out completely and by completing this form I hereby give permission for my child to participate in and be photographed at the Maconaquah Lady Braves Basketball Academy Camp. Photos only used for future camp forms and program updates. I also allow the camp's supervisors to assume “in loco parentis” in my stead. I acknowledge camp is non-refundable and the camp director has the right to refuse enrollment to any child. I fully understand and respect the camp director’s right and obligation to run camp as he sees fit especially when pertaining to discipline, which may as a last result end up in dismissal from the camp without a refund. I release and will not hold the school corporation, camp director, or staff liable or responsible for any accidents or injuries that may occur. I have adequate hospitalization insurance to cover any such injuries.
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Correo electrónico *
Parent/Guardian Name *
Parent/Guardian Cell # *
Alternative Emergency Contact Name *
Alternative Emergency Contact Relationship *
Alternative Emergency Contact Cell # *
Child #1 Name *
Child #1 Age *
Child #1 Grade *
Any medical issues limiting full participation? *
Child #2 Name
Child #2 Age
Child #2 Grade
Any medical issues limiting full participation?
Child #3 Name
Child #3 Age
Child #3 Grade
Any medical issues limiting full participation?
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