BEGINNER BASKETBALL CAMP Boys & Girls 2019 Coach Musick Dates: June 27-28, 9-11am Ages: 4-6 Site: SWOSU Wellness Center Cost: $65.00 For more information contact Kelsi Musick or Cophie Anderson kelsi.musick@swosu.edu or cophie.anderson@swosu.edu 580/302-3926 or 817/658-6795 _______________________________________________________________________________________ Name:_____________________ Address:_________________________________ City State Zip________________________________ Home Phone:________________ Emergency Phone:_____________________ Email address:____________________________________________ Age:______________ Grade (just completed):__________________ School:________________________________ T-SHIRT SIZE (circle one) : Youth: S M L Liability/Insurance Statement I hereby authorize the staff of Kelsi Musick Basketball Camp to act for me according to their best judgment in any emergency requiring medical attention and I waive and release the camp from any/all liability for injuries incurred while at camp. Please list all previous health conditions the Camp staff needs to be aware of (i.e. asthma, concussions, allergies, injuries, etc.)___________________________________________________________________________________ Insurance Company________________________________ Policy #________________________________ Signed (Parent’s or Guardian’s Signature):_____________________________________________________ Please return this portion along with payment to: Kelsi Musick - WBB - Beginner Camp 100 Campus Dr. Weatherford, OK 73096