June 5th-8th Monday-Thursday
REGISTRATION
June 5th-8th Monday-Thursday
FORM
Registration due by Friday, May 19th to ensure camp t-shirt . Camper Name: ______________________________
Incoming Grades K-4
_____ Gopher All-Star Camp: June 5-8 (11:00-12:30 PM) Elementary Gym Cost: $35
Incoming Grades 5-8
______ Gopher Elite Camp: June 5-8 (12:30-2:00 PM) High School Main Gym Cost: $35
Total Payment
$_____________________
Please check the session you plan to attend.
Return this form with payment. Make checks payable to: Clinton Prairie Boys’ Basketball
Email: _____________________________________ Phone #: ___________________________________ Incoming Grade: ______________ Age: __________ Shirt Size: (circle) AS
AM
YS
YM
AL
AXL
YL
___________________________________________ I agree that on behalf of the enrolled students named on this registration form, Clinton Prairie High School and/or the Gopher Boys’ Basketball Camp and/or their staff will not be held responsible for any injury, accident, or loss of property, however caused. It is further agreed that all risks involved are assumed by the student and his parent or guardian, who are also responsible for the medical fitness of the enrollee and for all medical costs incurred in
I have read the above and consent to the terms as stated. ______________________________________ Parent/Guardian Signature ______________________________________ Date
June 5th-8th Monday-Thursday
FORM
Registration due by Friday, May 19th to ensure camp t-shirt . Camper Name: ______________________________
Incoming Grades K-4
_____ Gopher All-Star Camp: June 5-8 (11:00-12:30 PM) Elementary Gym Cost: $35
Incoming Grades 5-8
______ Gopher Elite Camp: June 5-8 (12:30-2:00 PM) High School Main Gym Cost: $35
Total Payment
$_____________________
Please check the session you plan to attend.
Return this form with payment. Make checks payable to: Clinton Prairie Boys’ Basketball
Email: _____________________________________ Phone #: ___________________________________ Incoming Grade: ______________ Age: __________ Shirt Size: (circle) AS
AM
YS
YM
AL
AXL
YL
___________________________________________ I agree that on behalf of the enrolled students named on this registration form, Clinton Prairie High School and/or the Gopher Boys’ Basketball Camp and/or their staff will not be held responsible for any injury, accident, or loss of property, however caused. It is further agreed that all risks involved are assumed by the student and his parent or guardian, who are also responsible for the medical fitness of the enrollee and for all medical costs incurred in
I have read the above and consent to the terms as stated. ______________________________________ Parent/Guardian Signature ______________________________________ Date
