RAIDER BOYS BASKETBALL CAMP
RAIDER BOYS BASKETBALL CAMP
(Entering Grades 5th-12th, Boys) Coach Alexander with the Loudoun County Boys Basketball coaching staff are hosting the 11th annual Raider Basketball Camp. There will be an emphasis on teamwork, fundamentals, importance of school and having fun! Call 703-777-0343 for more information. Please register prior to camp. Walk-in registration will not be accepted. Location: Loudoun County High School, Leesburg
621110-01 M-F 621110--02
$110.00 7/11-7/15 $110.00
Entering 5th-8th 8:30A-11:30A Entering 9th-12th
Registration Form Participant Name ______________________________________ Parent Name ______________________________________ Social Security # ___________________________________________ or Driver’s License # Address __________________________________________________________________ State ______ Zip ___________________ Home Phone ___________________ Work Phone ________________________ Email Address ____________________________
Emergency Contact 1____________________ (H) Phone _______________ (W) Phone _______________ Grade Participant Will Be In ____________ School Participant Attends (Fall 07) ________________________ PRCS Desk: 703-777-0343 Sports Cancellation Line (703)771-0456 Website: www.loudoun.gov/prcs
Child’s Name
Child’s Birthday
Camp Code
Date
T-Shirt Size
Fee
I wish to register my children in the camps listed above. By signing below, I am stating that I give permission for my child( ren) to participate in all camp activities and that I understand the possible risks involved with this type of activity. I absolve the County of Loudoun, organizations jointly sponsoring the camps, and owners of any camp site locations of any responsibility for any accident or injury to my child(ren) or caused by my child(ren) to others where neglect is not involved. Furthermore, I understand that Parks, Recreation and Community Services (PRCS) will not be responsible for my child(ren) when he/she is traveling to and from a PRCS activity via transportation not provided by Loudoun County. I understand that registration minimums will be assessed two weeks prior to the date a specific camp is offered to determine whet her the camp will be held or not. Non-county residents will be assessed an additional 50% of the fee. Signature of Parent/Guardian ______________________________ Date ___________________________
Do you require a modification in order to participate in this activity: YES/NO
NO Walk-In Registrations will be accepted. Participants must pre-register by : Checks payable to County of Loudoun 1. On-line at www.loudoun.gov/prcs using Web Trac Registration 2. Mail payment and form to: 20145 Ashbrook Pl, Suite 170, Ashburn, VA 20147 2 weeks prior to camp start 3. Take form and payment to any Loudoun County Community Center or Recreation Center.
(Entering Grades 5th-12th, Boys) Coach Alexander with the Loudoun County Boys Basketball coaching staff are hosting the 11th annual Raider Basketball Camp. There will be an emphasis on teamwork, fundamentals, importance of school and having fun! Call 703-777-0343 for more information. Please register prior to camp. Walk-in registration will not be accepted. Location: Loudoun County High School, Leesburg
621110-01 M-F 621110--02
$110.00 7/11-7/15 $110.00
Entering 5th-8th 8:30A-11:30A Entering 9th-12th
Registration Form Participant Name ______________________________________ Parent Name ______________________________________ Social Security # ___________________________________________ or Driver’s License # Address __________________________________________________________________ State ______ Zip ___________________ Home Phone ___________________ Work Phone ________________________ Email Address ____________________________
Emergency Contact 1____________________ (H) Phone _______________ (W) Phone _______________ Grade Participant Will Be In ____________ School Participant Attends (Fall 07) ________________________ PRCS Desk: 703-777-0343 Sports Cancellation Line (703)771-0456 Website: www.loudoun.gov/prcs
Child’s Name
Child’s Birthday
Camp Code
Date
T-Shirt Size
Fee
I wish to register my children in the camps listed above. By signing below, I am stating that I give permission for my child( ren) to participate in all camp activities and that I understand the possible risks involved with this type of activity. I absolve the County of Loudoun, organizations jointly sponsoring the camps, and owners of any camp site locations of any responsibility for any accident or injury to my child(ren) or caused by my child(ren) to others where neglect is not involved. Furthermore, I understand that Parks, Recreation and Community Services (PRCS) will not be responsible for my child(ren) when he/she is traveling to and from a PRCS activity via transportation not provided by Loudoun County. I understand that registration minimums will be assessed two weeks prior to the date a specific camp is offered to determine whet her the camp will be held or not. Non-county residents will be assessed an additional 50% of the fee. Signature of Parent/Guardian ______________________________ Date ___________________________
Do you require a modification in order to participate in this activity: YES/NO
NO Walk-In Registrations will be accepted. Participants must pre-register by : Checks payable to County of Loudoun 1. On-line at www.loudoun.gov/prcs using Web Trac Registration 2. Mail payment and form to: 20145 Ashbrook Pl, Suite 170, Ashburn, VA 20147 2 weeks prior to camp start 3. Take form and payment to any Loudoun County Community Center or Recreation Center.
