Boys Registration Form

Jeffersonville Lady Red Devils & Jeffersonville Parks K-2 Girls Basketball Camp 2017

This camp will focus on skill development and fundamentals under the direction of varsity girls’ coach Michael Warren, staff, and players.

DATES: MAY 22-24(Grades K-2)

TIME: 5:45-7:00 @ Nachand Fieldhouse

COST: $20 per participant. Campers will receive a t-shirt.

CONTACT: Coach Michael Warren [email protected] (812) 282-6601 Ext. 15327 Coach Sara Nord [email protected]

Player’s Name: ______

Parent/Guardian Name(s): ______

Address: ______

City: ______State: ____ Zip: ______

Home Phone: ______Cell Phone: ______

E-mail: ______Age: _____ Birth date: ___ /___ /______

School: ______Current Grade: ______

Shirt size: (circle) Youth S Youth M Youth L Adult S Adult M Adult L Adult XL

WAIVER AND RELEASE OF LIABILITY

My daughter has permission to attend and participate in the Jeffersonville Lady Red Devils Basketball Camp. I have no knowledge of any physical impairment that would affect or be affected by my daughter’s participation in this camp. I specifically waive and release the Jeffersonville High School girls’ basketball coaching staff, the Greater Clark County School Corporation and Jeffersonville Parks Department of liability for any injuries that may occur as a result of this camp.

X ______Parent’s/Guardian’s Signature Date Signed Emergency Phone No(s). Return completed registration form and payment. Cash or Check Payable: Mail Registration and Payment: Jeffersonville Girls Basketball Camp Jeffersonville High School Attention: Coach Michael Warren 2315 Allison Lane Jeffersonville, IN 47130