BOYS 2017 VIKING BASKETBALL CAMP REGISTRATION FORM

Please TYPE in responses, PRINT form, and remember to SIGN form.
LAST NAME FIRST NAME NICKNAME
ADDRESS CITY STATE ZIP
DATE OF BIRTH GRADE & SCHOOL FALL 2017
HOME PHONE EMERGENCY PHONE
EMAIL
CAMP SESSIONS ***VIKING BOYS BASKETBALL FOR GRADES 2-9 ONLY***
BOYS:
June 26th-30th 8:30AM-3:00PM (Grades 2-9)
June 26th-June 30th 7:00AM-5:00PM with Before & After Care (Grades 2-9)

T-SHIRT SIZE YM YL AS AM AL AXL
PAYMENT: Tuition for camp is $275.00; tuition with Before & After Care is $325

Early Enrollment Discount - Registration form mailed before June 1, 2017 Tuition $250 ($300 with Before & After Care)

PARENT AGREEMENT
I certify that the named participant is in good health and physically able to participate in this camp. I understand the risk involved with such participation. My child is currently covered by medical insurance. I will in no way hold the Camp, the director, the staff, or the Viking Backers responsible for any injuries resulting to my child while participating in the Viking Basketball Camp.
Name of Participant
Signature of Parent/Legal Guardian DATE
Parent/Guardian's Printed Name
Make check payable to VIKING BASKETBALL CAMP and MAIL check and form to:
BOYS FORMS: Viking Basketball Camp
c/o Mike Linsenmeyer
6730 Allview Drive
Columbia, MD 21046