Boys Basketball Camp Registration Form

PRINT AND MAIL

Name ________________________________ Address__________________________________

City _______________________ Zip Code___________ Phone ___________________

Birthdate___________

School ___________________________________ Grade (’08– '09 school year)__________

In Case of Emergency Contact: _____________________________ Phone _________________

Parent’s/Guardian’s Signature:______________________________________________________

Circle T-Shirt Size

(adult) small medium large x-large (youth) large medium

CONSENT AND WAIVER

I hereby agree on behalf of the named student and her parent or legal guardian, to waive
any claims for liablility against the school, the Diocese of Harrisburg (and any Diocesan
or school officials, agents or employees) which may arise from the participation of the
named student in the Lebanon Catholic Boys Basketball Camp.

__________________________________
(Print Parent's Name)

__________________________________
(Parent's Signature)

__________________________________
Date