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Snow Valley Basketball Shooting Camp Attn: Dave Schlabaugh Box 1110 Williamsburg, IA 52361
NAME (Print Clearly) _________________________________
Camp Fee - $40 Includes T-Shirt Location: Lebanon, MO!!!!Boy ___ Girl ____
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 __________________________