2007 AHA Basketball Academy Registration Form

Please return the signed registration form with a $100 non-refundable check or payment in full payable to:                                                                                               

American Hebrew Academy Sports Camps                                                                                                                                                                           4334 Hobbs Road                                                                                                                                                                                                      Greensboro, NC 27410
 (Check the appropriate circles below) 
June 24-28 Skills Camp              Commuter $170 O    Resident $370 O  
June 17-21 Boys Team Camp       Commuter $170 O     Resident $270 O  
July 8-12 Girls Team Camp           Commuter $170 O     Resident $270 O

                  

 

 

 

Last name________________________________      First Name______________________________________
 

Address________________________________________________________

 

 

City______________________________            State________________    Zip Code___________________            

 

 

Home Phone__________________________

 

 

Parent E-Mail (All correspondence will be sent to this e-mail)___________________________________    

 

Date of Birth_______________________        Age____________        Male______  Female_______    Grade (Fall '06)_____________       

 

Shirt Size (circle one) youth l  adult s  adult m  adult l  adult xl
 

Roommate Request_____________________________________
 

Parent First and Last_____________________________      Parent Cell Phone_(_____)_____________
 

Insurance Company and Policy Number________________________________________________ 

 

Allergies or Special Medical Conditions________________________________________________
 

Emergency Contact_______________________        Emergency Contact Phone_(_____)___________

 

 

By signing this waiver I agree that my $100 deposit is non-refundable  (except in the case of disabling injury when $50 is refunded), and my final payment is due 14 days prior to camp.  A fee of $15 will be applied for all late payments.  I understand that my child is not guaranteed a spot in camp until the AHA Basketball Academy receives this application, waiver signature, and a $100 deposit or payment in full.  By signing this waiver I grant permission for the directors, assistants or other persons responsible to act on behalf of said minor in granting permission for evaluation and treatment of medical problems.  I understand that should a major medical problem arise, an attempt will be made to notify me by telephone.  In the event that I can not be reached, I hereby give my consent to such treatment as deemed necessary, including surgery, x-ray examinations and anesthesia to be rendered to said minor by a licensed physician or nurse.

 

 
 

Print Parent / Guardian Name___________________________            Signature________________________________