@ DENISON UNIVERSITY

Name:  ______________________________________   Address:  ____________________________________   City/State/Zip:  ________________________________   Parent  Phone:  ________________________________   Athlete  Phone:  _______________________________   Email:  ______________________________________   Grade  Entering:  _______  Ht:  ________  Pos:  _______   School:  _____________________________________   High  School  Coach:  ___________________________   Coach  Phone:  ________________________________   Coach  Email:  _________________________________   Please  Send  Registration  and  Fee  to:   Chris  Sullivan  -­  Men's  Basketball   Denison  University   200  Livingston  Drive   Granville,  Ohio  43023   Make  checks  payable  to:  Denison  University   Basketball   *A  $75.00  deposit  is  required  with  this  registration.   *  Deposit  is  non-­refundable  after  Monday,  July  5th   Name  of  Minor:  _______________________________   I,  ____________________________________,  being   the  parent  or  and  legal  guardian  of  the  above  named,   do  hereby  certify  that  my  son  is  in  good  health  and  may   participate  in  all  camp  activities.  I  hereby  appoint  Bob   Ghiloni  and  Dan  Priest,  camp  directors,  to  act  on  my   behalf  in  authorizing  medical  attention.  I  release  and   discharge  Denison  University,  Kenyon  College,  Bob   Ghiloni,  and  Dan  Priest  from  any  liability  whatsoever   during  my  child's  participation  at  the  Denison  &  Kenyon   College  Basketball  Prospects  Camp.     Emergency  Phone  #:  ___________________________   Parent  Signature:  ______________________________   Date:  ________________________________________

2017

Mitchell Athletic Center

MEN'S BASKETBALL PROSPECT CAMP HOSTED BY

DENISON UNIVERSITY & KENYON COLLEGE

July 29 & 30, 2017

    @ DENISON UNIVERSITY GRANVILLE, OHIO