University of San Francisco Attn: MBB 2130 Fulton Street San Francisco, CA 94117
Address Correction Required
INDIVIDUAL CAMP REGISTRATION Please Check the Sessions you wish to Attend
REX WALTERS
June 6th through June 10th (Individual Camp)
June 13th through June 17th (Individual Camp)
June 17th (Parent - Child Camp)
June 20th through June 24th (Individual Camp)
June 27th through June 30th (Individual Camp)
BASKETBALL CAMPS
Name
2011 INDIVIDUAL CAMPS:
Address
JUNE 6 - 10 JUNE 20 - 24
City
JUNE 13 - 17 JUNE 27 - 30
2011 TEAM CAMP: JUNE 10TH, 11TH &12TH
PARENT-CHILD CAMP: JUNE 17TH
Parent’s Name
State
Zip
E-mail Address Phone (
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Date of Birth
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Grad Class
School Emergency Contact Emergency Contact Phone (
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Medical Conditions of Importance
All camps are to be PAID IN FULL at time of registration CC#
EXP
CHECKS PAYABLE TO: REX WALTERS BASKETBALL CAMPS University of San Francisco MBB, Attn: Wendell Raiford, 2130 Fulton Street, San Francisco, CA 94117 (415) 422-5279 CANCELLATION POLICY: Registration credits will be issued for cancellations made 30 days prior to the start of each camp session. Credits are fully transferable. In case of illness or injury during camp week, pro-rated credits will be rewarded for next year’s camp. RETURNED CHECKS: There will be a $25 charge for all checks returned due to insufficient funds. I hereby authorize the staff of the Rex Walters Basketball Camps to act for me in accordance with their best judgement in any emergency requiring medical attention & hereby waive & release the camp, its officers & its employees from any & all liability for any injuries or illness incurred while at camp. I have no knowledge of any physical impairment that would be affected by the above camper’s participation in the camp program, as outlined in this brochure (including strenuous physical activity).
Parent / Guardian Signature Health Insurance Provider Agreement / Group #
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Policy #