*****Check out the Camp Info and former Northeast Guilford Ram player Abdul Tijani will be there….*****
EARL LLOYD ACADEMY BASKETBALL CAMP APPLICATION
City:_____________________ State: ____ Zip: ________
Home Phone:________________ Cell Phone:_____________________
Grade (next year): _____
T-shirt size Youth: XS__ S__ M__ L__ XL__
T-shirt size Adult: XS__ S__ M__ L__ XL__
A registration fee of $80 cash is currently being accepted.
Informed Consent and Release Authorization for Emergency Treatment Form
As the parent or legal guardian of the child named on this application, I hereby give my full consent and approval for my child to participate as a member at this Basketball Camp.
I understand that there are certain risks of injury inherent in the practice and play at this camp, as well as other related activities incidental to my child’s participation, and I am willing to assume these risks on behalf of my child. I hereby certify that my child is fully capable of participating at this Basketball Camp and that my child is healthy and has no physical infirmities that would restrict full participation in these activities, except as listed below.
In addition to giving my full consent for my child’s participation, I do hereby waive, release and hold harmless the organization of this Basketball Camp, its officers, coaches, sponsors, supervisors and representatives for any injury that may be suffered by my child in the normal course of participation in the basketball camp. In the case of an emergency, I authorize the staff at this Basketball Camp to obtain medical treatment for my child.
Please list any physical limitation (allergies, hearing, sight, etc.): _______________________________ __________________________________________________________________________________
Parent/Guardian Signature: ____________________________________ Date: _________________
June 11-15 (9 a.m. until 12p.m.) Ragsdale YMCA 900 Bonner Dr. Jamestown, NC 27282 …
PLEASE RETURN ALL APPLICATIONS TO JAMES WHITFIELD AT 336 340 8215 OR Abdul Tijani AT 336-509-2864