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Winter Basketball Camp Registration
Middle School Grade 6th - 8th
Put on by Lake City Boys Basketball Program
Event Timing: January 2-4, 2018, 11:00-1:00
Event Address: Lake City High School
Contact James Anderson @ (208) 284-2918 or
janderson@cdaschools.org
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Player Name
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Gender
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Female
Male
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School Currently Attending
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Lakes MS
Woodland MS
Canfield MS
Home School
Private School
Other:
Grade for 2018-19 School Year
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6th Grade
7th Grade
8th Grade
Required
Parent Names:
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Your answer
Parent Phone #'s
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Your answer
Parent Email Address
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Your answer
Additional Emergency Contact Person + Phone#
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Your answer
Health Insurance Information - Include Company and Policy Number
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Your answer
Medical Authorization - I hereby authorize my child’s participation in the Lake City Basketball Camp. I know of no physical or mental disorders which may affect my child’s ability to participate in this camp. I recognize the risks inherent in my child’s participation, and I assume full responsibility for all injuries that may arise. I waive and release the Coeur d’Alene School District and all instructors from any and all liability for any injuries incurred while participating in this camp. Type Your Name Below to Agree with Medical Authorization
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Dietary restrictions, allergies, medical conditions we need to be aware of?
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I understand that I will have to pay $$ upon arrival - $50 or $30 for 2nd person from same family. Checks payable to "Lake City Basketball".
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Yes
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