Name (First and Last) Date of Birth (mm/dd/year)
Parent / Guardian Name
Grade in School in Fall 2003
Address
Height (Feet / Inches)
City
Sex (Male / Female)
Male Female
Province
Emergency Contact
Postal Code
Emergency Contact #
Home Phone Number
Work Phone Number
E-mail Address

Put a checkmark for the camp you will attend.
 
Boys and Girls Camp  
July 7, 8, 9 ,10, 11 (Mon to Fri) - (9:00 am to 12:00 pm) - (entering grade 7, 8, 9, 10, 11 in the fall)
$125
   
**All camps will be held at Rockridge Secondary School.**  
**Due to demand for places in the camps, we must adopt the following policy. All fees are non-refundable except for medical reasons or family emergencies. Requests for medical refunds must be accompanied by a physician’s letter. Any withdrawal (medical or family emergencies) after June 9th, 2003 will result in a $50 administrative fee plus the cost of the basketball jersey.**  
   
Put a checkmark for the size of the basketball practice jersey.  
X-Large Large Medium Small  

Medical Authorization / Waiver
If any emergency occurs, I authorize the basketball camp staff members to take all proper action and use the emergency service available at the nearest hospital, if necessary. I understand my personal insurance will be used in this case and the proper calls will be made to you before any medical attention is given. In the case of extreme emergency, I authorize the emergency personnel to take proper action.
I agree Signature
 
In and for consideration of my son's / daughter's participation in the Rockridge Basketball Camp, I hereby agree and promise that I will not hold Rockridge Basketball Camp, nor its staff responsible for any loss, damages, or personal injuries that he / she may receive as a result of participation. The Camp Directors reserve the right to request any camper to withdraw from the camp prior to its termination without refund, if in their opinion the camper is not following behaviour rules set out. The refund policy above applies. If the camps do not have enough participants, the camp directors have the right to cancel any session with a full refund.
I agree Signature