Registration Form:

Name______Address______City______Zip Code______Email______Contact phone ______Grade (next year)______Age______T-Shirt size (adult sizes) ______Lunch M-Thrs $15 Yes No Total Included (registration + optional lunch)______

Kentwood High School co-curricular Activities Parent Waiver: Your son/daughter ______has expressed a desire to participate in the 2016 Conqueror Basketball Camp. The activity will be properly supervised by a member of our teaching staff. By signing below you agree to hold harmless the Kent School District and the Kentwood Black & Silver Booster Club, both individually and collectively from all demands, claims, actions and damages, if any asserted by the undersigned or anyone on their behalf, arising out of incidents occurring on this above mentioned activity that are beyond the influence of the supervising staff. If any injury occurs one must use personal insurance coverage to cover medical expenses.

______(Student name) is hereby granted permission to participate.

Parent/Guardian Signature______

Student Signature______

Mail Registration to: Black & Silver Basketball Booster Club PO Box 8332 Covington, WA 98042