PARENTS: PHONE: CELL: INSURANCE CO: CAMPERS NAME: GRADE NEXT FALL: SCHOOL:
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1 June 13th 17th, 2016 CAMPER REGISTRATION: PARENTS: PHONE: CELL: INSURANCE CO: CAMPERS NAME: GRADE NEXT FALL: SCHOOL: T SHRIT SIZE: YM YL S M L XL XXL COST: $50 FAMILY FEE: 2 CAMPERS ($80) 3 CAMPERS ($90) Make checks payable to: MCHS Mail application and check to: MCHS c/o Dina Hackert 938 Old State Rd Brandenburg, KY Camp Features * Grades 3rd - 8th (for school year) Camp begins at 1:00 pm and ends at 5:00 pm. Instruction from MCHS Girls Coaching Staff with past and present players * Dribbling, Shooting, Offensive Moves, Defense & Teamwork * Guest Speakers * Free Camp T-shirt Individual & Team Awards (Friday at 4:30 pm) I authorize Meade County High School, the director of the Ladywave Camp, and the staff to act for me according to their best judgment in any emergency requiring medical attention for my child. I waive and release the camp and its staff from all liabilities for any injuries incurred while at camp. I also understand that I am responsible for any cost incurred due to injuries received in camp requiring medical or dental expenditures. I certify that my child is physically able to participate in the activity of basketball. X Date: Signature of Parent / Guardian
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