Coach Deron Breeze - 2023 Basketball Camp Registration
Basketball Camp will take place at Adair County High School gymnasium Monday July 24 - Wednesday July 26th. Camp times will be 8:30 AM - 11:45 PM daily with each camper receiving a T - Shirt along with many games and awards. Camp is available for Boys and Girls who will be entering grades K - 6  in the fall of 2023.

NO PAYMENTS are accepted until the first day of camp. 

Prices are $45 per camper / $35 for siblings if registered by July 10th. 

Walkups or online registrations after July 10th will have price increases to increases to $50 per camper / $40 for siblings and t-shirt size will not be guaranteed.
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Camper(s) Name [ First, Last ]                                                                                        
 Note -- If registering siblings, please separate their name by using a numerical system in the box below, you do not have to fill out multiple registration forms.
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Camper(s) School *
Camper(s) Grade for the 2023-2024 School Year                                                         
Note --- if registering siblings, please check box each campers grade and also click other, and note there which camper is in which grade.
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Required
Camper(s) T Shirt Size                                                                                                       
Note --- if registering siblings, please check box each campers shirt size and also click other, and note there which camper will receive which shirt size.
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Required
Parent / Guardian Name ( First, Last ) *
Parent / Guardian Contact Phone Number *
Parent / Guardian Email Address if Applicable
Method of Payment *
Required
Being the parent or guardian of the participant (s) named on this registration who is a minor. I accept and assume any and all risks associated with his / her / their attendance and participation in this basketball camp and its activities. I understand that my child (ren) must abide by camp policies and the instructions of the camp staff. I agree that should my child be dismissed from camp no part of my tuition will be refunded. In the event that I cannot be contacted in an emergency. I hereby grant Coach Deron Breeze's Basketball Camp staff to give immediate assistance and / or take my child to the hospital / emergency room. Permission is hereby granted for photographs and or videos to be taken of my child at camp and can be used as basketball camp promotion via our social media account. Knowing these facts and in consideration for your accepting my child(rens) application Coach Deron Breeze and Adair County Schools are not responsible for accidents, injuries, and  / or medical or dental expenses arising from my child(ren)'s participation in the camp and accordingly, I covenant not to sue, and waive, release, and discharge Adair County School & Coach Deron Breeze Basketball Camp staff from any and all claims of liability or expenses of any kind or nature whatsoever arising out of or relating to my child(ren)'s participation in the camp. I have carefully read all of the information in this application and agree to all conditions by clicking "YES" I agree to the above terms. *
Required
Special Requests / Additional Information
Name of person filling out this form *
Todays Date *
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