T-Shirt Size ________________ Position _____________________ Name of Participant _____________________________ School and Grade _________________________________ Email _____________________________

ADVANCED CAMP
or
DEVELOPMENT CAMP

(Please circle one)

Please make checks payable to: Kettle Run High School Please mail applications to: Attn: Troy Washington Kettle Run High School 7403 Academic Ave. Nokesville, VA 20181

KETTLE RUN CO-ED SKILL

phone

(540) 422-7330

MEDICAL RELEASE
KRHS DEVELOPMENT CAMP

JULY 9-11, 2013

GRADES 3 - 6 (9AM - 12PM) EARLY REGISTRATION:

$75

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water/gatorade

GRADES 6 - 10 (9AM - 2PM) p rat h t c s a n e o fe o ts o d dem er. Thes EARLY REGISTRATION: $100 sist c n e o th an ay asp ill c pw am ectures tball pl n by bo e m t a l c d l aske e give k e t b a l l an clude bring a bagged lunch This a b u r e b d n i i s t l l t v l a l i i o e a s b d l b w b a in a s rsit y basket lp will ecome tration a p v t s Cam s to b mons boy presen p to he y d e a n / d m t a on w es and ir ls ral pas ging ca m e ! g r n e u n ga lect ttle Ru ith sev challe heir
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S H R K JUNE 24-27, 2013

*

AN V D A

M A C CE

My daughter/son is physically capable of participating in the camp. I hereby give my permission for a qualified physician, certified athletic trainer and/or hospital emergency personnel to administer necessary medical attention, or camp staff to administer necessary first aid in case of injury. I also understand that Kettle Run High School, nor anyone connected with the camp, will assume responsbility for accidents, or other expenses incurred as a result of accidents during the camp.

________________________________

Parent Signature:

EMERGENCY CONTACT INFO

_______________________________

Emergency Contact:

_______________________

Relation:

basketball shoes

( _______ )________-________

Phone: