Incoming 1st-8th Grade Jr. Grizz Basketball Camp Registration Form May 19-21, 2015 Player’s Name __________________________________________ Date___________________ Date of Birth _________/_________/________ Age ________ 2015-16 Grade ________ 2015-16 School____________________ Shirt Size: (mark one please) Adult – XL L M S OR Youth – XL L M S Parent or Guardian ______________________________________________________________ Mailing Address ___________________________________City_____________Zip_________ Home Phone___________________________ Cell Phone____________________________ Email address__________________________________________________________________ Emergency Contact _____________________________ Relationship ____________________ Emergency Contact Phone ____________________ Other Information (medical problems, special considerations, etc.) $PTUJTQMBZFS1BZBU SFHJTUSBUJPOCZDIFDLPOMZ NBEFQBZBCMFUP-PHBO #PZT#BTLFUCBMM 1MFBTFOPUFUIBUXFDBOOPU BDDFQUDBTIQBZNFOUT In consideration for my child’s registration as a participant in the above entitled event, and with the understanding that my child’s participation in this event is only on condition that I enter into this agreement, for myself, and my child, I hereby assume the inherent risks involved in the Jr Grizz Basketball and any risks inherent in any other activities connected with this program. I expressly assume the risk of and accept full results of my child’s participation in this event and release from liability, Logan City School District, Logan Recreation Center and the Jr Grizz Program. I hereby waive any claim I may have hereafter of any result of my child’s participation. I have read and understand the above statement. Parents/ Guardian Signature: _____________________________________________________ Print Name: __________________________________________________________________