1. BEGINNER BASKETBALL CAMP Boys & Girls 2019 Coach Musick
Dates: June 27-28, 9-11am
Ages: Site: SWOSU Wellness Center Cost: $65.00
For more information contact Kelsi Musick or Cophie Anderson or
580/ or 817/
_______________________________________________________________________________________
Name:_____________________ Address:_________________________________
City State Zip________________________________
Home Phone:________________ Emergency Phone:_____________________
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