| Name | ||
| Address | ||
| City | State | Zip |
| Home Phone | ||
| Grade (Fall 2004) | Age | |
| School | Coach | |
| Adult T-Shirt Size: S M L XL XXL (circle one) | ||
| Roommate Preference (each must choose the other) | ||
|
Check the camp(s) you wish to attend and complete the necessay information ____ TEAM CAMP: July 9-11, 2004 ____ stay overnight and meals - $130 ____ commute and meals (no breakfast) - $100 ____ commute and no meals - $75 ____ INDIVIDUAL CAMP: July 11-15, 2004 ____ stay overnight and meals - $250 ____ commute and meals (no breakfast) - $200 ____ commute and no meals - $150 ____ BOTH CAMPS: July 9-15, 2004 ____ stay overnight and meals - $330 ____ commute and meals (no breakfast) - $250 ____ commute and no meals - $175 |
| PAYMENT | |
| AMOUNT DUE | $ |
| Non-refundable Deposit | - $75.00 |
| BALANCE DUE | $ |
(Make checks payable to Stan Swank Basketball Camp.)
My daughter has had a recent physical exam and is physically able to participate in all clinic activities and is free from infectious diseases. I relieve the Director and Edinboro University of any responsibilities should any accidents occur. I give consent for the Edinboro trainers and doctors to treat my daughter in case of injury or illness. I give consent for my daughter to attend and participate in Stan Swank Basketball Camp.
| Signature of Parent/Guardian |
| Date |
Send completed application and payment to: Stan Swank, Head Women's Basketball Coach, McComb Fieldhouse - Room 108, Edinboro University, Edinboro, PA 16444.