2008 COUGAR BASKETBALL CAMP

July 7-11, 2008

APPLICATION FORM

CAMP FEE: $150 PAYMENT MUST ACCOMPANY THIS APPLICATION!

NAME ______________________________________________________________________

ADDRESS ___________________________________________________________________

CITY _________________________ STATE____ZIP __________ PHONE _________________

EMAIL ADDRESS __________________________________ BIRTHDATE ________________

AGE AT TIME OF CAMP _____________ GRADE IN FALL, ‘08 ____________

EMERGENCY CONTACT _______________________  EMERGENCY PHONE ___________

WAIVER

By signing this application, I acknowledge that inherent in this activity is the potential for injury.  I further represent that my child is physically and emotionally capable of fully participating in all activities associated with the camp.  I acknowledge and agree that KVCC, its employees, agents and contractors has not made, and has no obligation to make, any determination as to my child's fitness for participation in this activity and that KVCC, its employees, agents and contractors shall not be liable for any loss, injury or death related to my child's attendance and participation.  My signature on this document further indicates my permission for my son to have his picture displayed on the www.kvcc.edu website.

PARENT’S (or legal guardian's) SIGNATURE

 ___________________________________________________________

 

 

IF PAYING BY CREDIT CARD, PLEASE PROVIDE THE FOLLOWING INFORMATION:

Type of card: VISA _____ MASTERCARD _____ DISCOVER _____ EXP. DATE ______________

NAME CARD IS ISSUED TO: ____________________________ACCOUNT #___________________

AMOUNT $__________ SIGNATURE ____________________________________________________

[Camp Information Form]    [Camp Home Page]    [Athletic Home Page]

PLEASE MAIL APPLICATION AND PAYMENT TO:

Kalamazoo Valley Community College
Financial Services Office
P.O. Box 4070
Kalamazoo, MI 49003-4070