Spring Break Camp 2012
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March 11, 12, 13 8:00 AM - 10:00 AM (Ages 6-11) 10:00 AM - 12:00 PM (Ages 12-14) |
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Details Cost: $90.00
The Honor Roll School 4111 Sweetwater Blvd. Sugar Land, TX 77479
Questions: (713) 569-9950 or bjambcamp@gmail.com |
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Registration Information Circle Desired Session: Session 1-March 11, 12, 13 Session 2-March 14, 15, 16 Camper's Name______________________________________ Age___ M__ F__ Address_______________________________________City___________________State___Zip____________ Home Phone_____________________________ Alternate #_______________________________________ Emergency Contact Name_______________________ Emergency Contact Number___________________ Email Address____________________________________________________________________________
As Parent or Guardian of the above named person I give approval for his or her participation in all basketball training activities. I assume the risk and hazards associated with his or her participation in all basketball training activities. I hereby authorize the staff of Larry Micheaux Basketball Academy and Basketball Clinic to act for me in the case of any emergency requiring medical attention. I hereby waive and release Larry Micheaux Basketball Academy, Basketball Clinic, and their staff, employees and volunteers of any and all liability. I consent to all video taping and photographing during training. I agree that no compensation will be paid to me or my child for the use of these images.
X_________________________________ Please Print Parent or Legal Guardian’s Name
X_________________________________ Date________________________ Signature
Make All Checks Payable To: Larry Micheaux Mail to: Larry Micheaux P.O. Box 17364 Sugar Land TX, 77496 |