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CONTACTS SV CAMP DIRECTOR Dave Schlabaugh daveschlabaugh@gmail.com Cell: 319-530-3274 ! Camp Fee - $40 Includes T-Shirt Snow Valley Basketball Shooting Camp Camp Location: Ballard High School Attn: Dave Schlabaugh Girl ______ Boy ______ Box 1110 Circle T-Shirt Size: Youth Large Small Medium - Large - XL - XXL Williamsburg, IA 52361
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NAME (Print Clearly) _______________________________________________ School ________________________________ Current Grade _____ Mailing Address __________________________________________ City _______________________________ State ______ ZIP __________________ Phone Numbers H_________________________________________ Cell ___________________________________________ Emails 1 __________________________________________________ Email 2 ______________________________________________ Emergency Phone Number _______________________________________ Please note any medical conditions that we should be aware of: ________________________________________________________________ I hereby authorize the Directors of Snow Valley Basketball School to act for me according to their best judgment in any emergency requiring medical attention and I hereby waive and release Snow Valley Basketball School from any and all liability for any injuries or illnesses incurred while at Snow Valley Basketball School. I will be responsible for any medical or other charges in connection with my childs attendance. I know of no medical or physical problem, which may affect my childs ability to safely participate in this program. Parent or Guardians Signature _______________________________________________________________________________ Parents Insurance Company___________________________________ Policy Number __________________________