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Location of Camp:

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Grades: to

Times Each Day:

Total Costs: $0

Description:

Coaches Information:
Host Coaches Name:
Address:
Address2:
City:
State:
Phone Day:
Phone Evening:
Coach's Email:

Camper Sign Up:
Name
Gender:	Boy Girl
E-Mail Address:
Home Address				Home Phone
Unit		City		State		Zip
School Name
T-Shirt Size	YL S M L XL XXL
Parent(s) Name
Disclaimer:
I am a Parent or Guardian of the camper registered herein. I hereby authorize the Program Director and all members of the Shot Doctor Camp staff to act on my behalf in any emergency situations requiring immediate medical attention. I also certify that the camper registered herein is covered by a comprehensive medical insurance plan or is self insured. I hereby release the camp staff, Shot Doctor Basketball, U.S.A., the Facility and any employee of the Facility of any and all liability for any illness or injury incurred by the above named participant while at camp or while in transit to or from camp.
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