Lady Spartan Basketball

BEST GIRLS West Springfield Girls Basketball CAMP FOR OVER 32 YEARS! Summer Camp 2016 ONLY SESSION Directed by Bill Gibson- Bill Langloh- Triahna Harris For More Info: 703-913-3873 or Email to: [email protected] Daily Week Camp Session July 11th – July 15th (this is our only session) The camp will be held at Washington Irving Middle School from 9:00am to 3:00pm. Each camper will receive a camp basketball, camp shirt, camper evaluation along with an experienced staff. On the last day of camp, team & individual trophies will be awarded along with a chance of winning the money shot. This camp is advisable for all girls entering 3rd thru 9th grade. Daily stations, lectures will be conducted & former players will be working. Camp cost is $175. Call for team or family discount. CAMP WILL BE HELD AT WASHINGTON IRVING MIDDLE SCHOOL. CUT HERE AND MAIL BOTTOM PORTION – MUST BE SIGNED

Camper Name:______Age:_____Grade :_____ Parents or Legal Guardian:______Address:______Phone: (H)______(C)______(W)______Email:______Check Amount:______Check #:______Date______

Make check payable and mail to: SPARTAN ATHLETIC BOOSTERS P.O Box 2238 Springfield, VA 22152

I, (parent/guardian), hereby give my permission for any and all medical attention necessary to be administered to my child in the event of an accident, injury, sickness, etc., under the direction of the person(s) listed below, until such time as I can be contacted. This release is effective for a period of one tear from the date of signature. I also hereby assume the responsibility of any such treatment.

INSURANCE INFORMATION Insurance Provider: Policy Number: . Hospital Preference: . Physician Name: Phone . Address: . Known Allergies: . Any Other Medical Conditions: .

DESIGNATED CONTACTS: Name: Number .

Name: Number .

Signed Parent/Guardian ______