2008 JUNIOR COUGAR BASKETBALL CAMP
July 14-18, 2008
APPLICATION FORM
CAMP FEE: $95 PAYMENT MUST ACCOMPANY THIS
APPLICATION!
NAME
____________________________________________________ Male _____ Female _____
ADDRESS
__________________________________________________________________
CITY __________________________ STATE____ ZIP
__________ PHONE _____________
EMAIL ADDRESS
__________________________________ BIRTHDATE ________________
AGE AT TIME OF CAMP _____________ GRADE IN FALL, ‘0
8
____________
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/daughter to have his/her 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 Page]
[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
